Applying to Residency this Cycle? Don't Forget the New AAMC Fee Assistance Program for Residency Applicants

Here's a quick reminder that the Association of American Medical Colleges (AAMC) is expanding its Fee Assistance Program (FAP) to residency applicants this year.

The good news is that if you were previously approved for the AAMC FAP, you will automatically get a 60% discount on your residency application for this ERAS season.

The bad news is that current medical students are not eligible to apply for the FAP even if they now have financial challenges that they did not have prior to medical school or if they qualified before medical school but declined to apply for the FAP benefits.

The AAMC says they are going to survey "the student affairs community" to understand "if and how" they can further expand the FAP for residency applicants.

Here is more information with some frequently asked questions.

Try a Residency Bootcamp

I was recently speaking to a medical student with excellent foresight, who was asking me what he could do to prepare himself for residency. I suggested reviewing the basics – perhaps by perusing a favorite clinic handbook – of how to work up common chief complaints like chest pain, shortness of breath, abdominal pain, back pain, among others. It was timely, then, that I read an article about Transition to Residency classes offered at the majority of medical schools. These intensive courses help medical students refresh their knowledge about clinical approaches, so they can hit the ground running when internship starts. 

If a Transition to Residency class is robust and offered at your institution, I would recommend taking it.

Also, when thinking about preparing for residency, I advised the student to consider ways to make life as smooth as possible: When I was in training, I splurged to pay for a laundry service. I never missed the money; instead of spending my downtime at a laundromat or an apartment complex laundry room, I was able to sleep a little more. 

Of course, I had to be frugal during residency, as many others do, but doing one or two things that can make your life better can pay dividends.

Check Out the AAMC Virtual Medical School Fair

The AAMC (Association of American Medical Colleges) will be holding a live informational medical school fair this Wednesday, April 10 through Friday, April 12. There will be sessions on financial issues like loans, budgeting, and scholarships and some advice from current medical students and admissions officers. Registering also affords you 15% off a one- or two-year subscription to the Medical School Admissions Requirements (MSAR®) website.

You can register here. I offer individually-tailored, one-on-one assistance, but there's no downside to hearing more general tips from the AAMC itself.

Major Changes are Needed to Head Off a Worsening Physician Shortage

 The AAMC recently published a report estimating that the United States will face a physician shortage of up to 86,000 doctors by 2036.  

A variety of issues are contributing to the problem, including the lack of adequate residency slots. A bipartisan bill called the Resident Physician Shortage Reduction Act of 2023 (H.R. 2389/S. 1302) has promise but has yet to progress through Congress. The legislation would gradually increase the number of Medicare-supported residency slots by 14,000 over the course of seven years.

Other issues are at play, including an aging American population, one that requires more healthcare. Additionally, doctors who are 65 and older make up 20% of the physician workforce, and those between age 55 and 64 constitute 22%, meaning that many doctors are reaching retirement age. 

A cohort also left clinical medicine during and after the pandemic, and, in a related issue, burnout is very high for those who stayed. A whopping 49% of doctors surveyed through the annual Medscape questionnaire reported being burned out.

The opaque medical school admissions process and the very high cost of medical school are also barriers.

Anecdotally, I hear of many family members who wait weeks or even months to see a physician. Most of those people live in urban areas; the problem is significantly worse in rural locations. Becoming a physician is a noble endeavor, but without structural support, many talented students will pursue other fields. We can't blame them.

My Five Year Anniversary with the White Coat Investor Podcast

Looking for a podcast episode for today's drive to work? Check out my take on entrepreneurship, creating autonomy and flexibility, and balancing clinical practice with raising a family on the White Coat Investor (WCI) podcast. The interview initially ran in March 2019, but the content is still highly relevant for those considering alternatives or enhancements to clinical careers.

For those of you who aren't familiar with WCI, it's a website/blog/podcast founded by James Dahle MD, an emergency physician whose interest in personal finance and the FIRE (financial independence - retire early) movement sparked a slew of devotees. Check out my podcast episode here (where you can also read the full transcript) or listen on your favorite podcast app. 

Leverage the MSAR for Your Benefit

The Medical School Admission Requirements database (MSAR) is an online resource that allows users to search, sort and compare information about U.S. and Canadian medical schools. (I hate to date myself, but when I was applying, the MSAR was a hard copy book.) The annual MSAR usually comes out this month or next; if you're applying to medical school, I'd recommend purchasing the 2024 version when it's here because it provides so much information about institutions and their admissions statistics. The MSAR allows you to compare schools by median MCAT scores, AMCAS GPAs, and other criteria. (Of course, how institutions utilize the MCAT score is variable, which contributes to the shameful opaqueness of the medical school admissions process.)

You should use the MSAR to help determine which schools are in your range and which are "reach" schools. While it's fine to have a lot of "reach" schools (if you can afford it), it's critical to ensure you are applying wisely to schools that match your numbers. The advantage of the MSAR is that you can make evidence-based decisions. I've found some applicants have eye-opening experiences when they thoroughly review schools' statistics and either realize that their numbers are low and that they should apply accordingly or, happily, that they have numbers that match with top schools. Either way, reviewing the data is critical to good decision making.

 

The Medical School Admissions Process is Totally Broken - From Start to End

The medical school admissions process is cruel. I recently told that to a strong applicant who was "ghosted" by five institutions this cycle. Poor or absent communication is only one of the problems. The lack of clarity about selection criteria causes confusion, and expensive supplementary applications that generate money for schools are sometimes exploitative.

Check out my Doximity op-ed piece "The Medical School Admissions Process is Falling Short," and feel free to leave a comment on the site about your experiences and opinions.

One Billion Dollars

I was super impressed with the news that Albert Einstein College of Medicine Professor Ruth Gottesman is donating $1 billion to her institution to make tuition free for all medical students going forward.

In 2019 NYU made medical school tuition free. Subsequently, the demand to go to their institution skyrocketed, as did their matriculants' median MCAT and AMCAS GPAs. According to the most recently published MSAR, NYU's median total and BCPM GPAs were both 3.96, and their median MCAT was 522. A similar phenomenon will occur with Albert Einstein School of Medicine.

The tremendously generous donation by Professor Gottesman allows earnest individuals interested in caring for our communities to become physicians without excessive debt. Of note, Albert Einstein offered to rename their school to include "Gottesman," but the professor declined, a choice which adds to her stature in my mind.

No One Wants to be your Second Choice for the High School Prom

Imagine you're back in high school, planning to ask out a fellow classmate to the prom. You approach your potential date, "Would you be interested in going with me to the dance? You're my second choice."

Not very compelling...The same is true for letters of interest or, really, any outreach to medical schools or residency programs: Over the years, I've edited many letters in which applicants mention that an institution is "one of my top" picks.

Avoid that type of language. Instead you can say something like "I would be thrilled to be at your institution," or "I am confident I can make a positive contribution." In other words, you can stay honest while not shooting yourself in the foot.

Let me know if you need assistance with a letter of interest.

This Has Been a Weird Cycle

I founded Insider Medical Admissions in early 2007, and, looking back, I'm struck by the fact that this is one of the longest medical school admissions cycles I remember. What I mean by that is I have applicants who were admitted to medical school in early fall, and, simultaneously, there are some who are still being invited for interviews at top schools, scheduled for this month and early March.

I've seen late invitations in the past, but they were few and far between. This year, it seems almost routine to be interviewing into the late winter.

If you're facing an interview this month or next, check out a couple of articles I wrote for Student Doctor Network years ago that have survived the test of time: One is about how to skillfully manage difficult interview questions and the other will teach you how to transform your candidacy's liabilities into assets. 

I'm still offering mock interviews this cycle, so contact me for help.

  

How Sesame Street Can Help You Write a Good Medical School Personal Statement

I learned an interesting fact years ago: When small children don't understand something, they will simply tune it out and start to engage in another activity. That's why great shows like Sesame Street use professionals to make sure their content is precisely age-appropriate. Children - and adults - don't like being confused, and you can’t blame them.

In their personal statements, some medical school candidates make the mistake of referring to an accomplishment without explaining it. This is understandable since we are all intimately familiar with what we've done. The problem is that the vast majority of application readers are way too busy to do independent research or go back and forth checking an applicant’s supporting documents if she writes something that isn’t crystal clear.

I remember a talented candidate I advised who showcased an award she had won. She listed the name, but didn’t explain what it was. When I asked her, she told me the award was an academic honor given to only the top 1% of students out of several thousand. I was impressed! And, I asked her to rewrite the section so that her admissions readers would give her the credit she deserved for that extraordinary accomplishment. Because the medical school admissions process is so competitive, what you fail to adequately explain counts against you.

On a related topic, don’t expect a reader to understand something in your essay because it’s explained in your AMCAS activities. Different faculty members will approach the application in different ways, so – to get “full credit” for your accomplishments - you need to assume that your reader is seeing your essay first, independent of your AMCAS activities. Ensure your personal statement can stand alone and doesn't rely on your AMCAS Activities section for clarification.

Contact me for help with your written materials. I have read thousands of essays, and I personally review every document sent to me.

The Medscape Physician Depression and Burnout Survey 2024 is out and the News Isn't Good

For the last several years I've made sure to blog on the annual Medscape Physician Survey that chronicles physician satisfaction. Unfortunately, it's pretty much always bad news.

If you're an optimist, you'll be happy to hear that burnout rates were lower than last year. You may remember that the numbers skyrocketed during the pandemic. Last year 53% of physicians surveyed reported burnout and 23% reported depression. This year the numbers are 49% and 20%, respectively. If you're a pessimist, you'll notice that those numbers are still very high, with approximately half of the doctors surveyed reporting burnout. That's a very big number.

Of note, emergency physicians are the most burned out at 63%, and the runner-up is obstetrics and gynecology at 53%. Plastic surgeons are the least burned out at 37%.

See more stratification and data by taking a look at the survey results here.

Which Specialties Have the Biggest Gender Gaps During Residency? You Will and Won't be Surprised.

The AMA recently published a short piece based on 2022-23 data culled from their National Graduate Medical Education Census: They evaluated which medical specialties were most popular among male and female candidates who were entering residency. They then extrapolated as to which specialties are going to be increasingly female- versus male-dominated.

Female-dominated specialties included obstetrics and gynecology, pediatrics/psychiatry/child and adolescent psychiatry (combined), pediatrics, allergy and immunology, public health and general preventive medicine, and dermatology.

I wasn't surprised that pediatrics or obstetrics and gynecology were female-dominated, but I found it interesting that dermatology - which is so well remunerated - has more women residents than male residents. Historically, women were relegated to lower paying fields.

Male-dominated specialties included orthopedic surgery, interventional radiology, neurological surgery, diagnostic radiology, and urology.

The AMA reports that specialties that offered a near equal balance of men and women in residency included neurology, general surgery, and psychiatry. Again, as someone who trained in the late 1990s, it's a joy to hear that general surgery is now a well-balanced field in terms of gender. On the whole, when the AMA included specialties, subspecialties, and combined specialties, they report that women account for 48.2% of trainees.

For more details, you can check out the AMA piece here.

There's a New and Improved ERAS Fee Structure on its Way

The AAMC recently announced an updated fee structure for the next ERAS cycle with the goal of lowering total application costs and simplifying the current cost framework, which has been criticized for its complexity. In theory, the change should be an improvement for this year's applicants.

Essentially, residency candidates will pay $11 per application for up to 30 and $30 per application for 31+. Of note, the structure restarts for any new specialty. So if you plan to apply to two, your costs will be higher.

The AAMC estimates most applicants will see discounts of up to 36%.

The old system was triple tiered. You can see it here. Of note, as I previously blogged about, this year the AAMC will also expand their Fee Assistance Program to include some residency applicants, a first.

You can see the new ERAS fee structure in graphic form here.

Make Sure to Read the Fine Print

Many years ago a medical school applicant told me the following story:

The student sent follow up notes to all schools where he had interviewed, usually a strategic move. However, he was very upset to receive a brusque note from one of the institutions telling him that a) he should have read their policies; they do not allow post-interview contact and b) he was rejected from the school.

I found the school's note extremely severe – almost cruel – and I strongly suspect the post-interview contact was not related to his rejection. (As an aside, he successfully and happily matriculated at another school.) But this story is a reminder that it's important to read institutions' policies about post-interview and post-waitlist contact. Most places welcome written updates, but make sure to confirm before you reach out.

Consider Ten Ways to Improve your Medical School Application

New Year's resolutions are notoriously hard to realize. But there are smart tips for executing them, including making sure goals are specific and truly achievable within a reasonable time frame. That's why starting early on your medical school candidacy is important. The beginning of the year is a great time for pre-meds to redouble their efforts toward their academic and professional goals. 

As always, I recommend a very focused approach that allows you to do more of what you want and less of what you don't. Think research will help your candidacy but don't like being in the lab? Consider public health or clinical investigations. Think volunteerism will bolster your application but don't like being one of a crowd in a group project? Select a setting that allows you to work independently: Several of my clients have chosen to volunteer on a crisis line – from home.

There are definitely necessary elements to any robust medical school candidacy (clinical experience, strong grades, a reasonable MCAT score), but being a pre-med can also be fun, mind-broadening, and career-affirming.

Here's a piece I wrote for Student Doctor Network showcasing ten ways to improve your medical school application. The idea is to give you direction but also leeway to be a happy applicant - not just a strong one.

Diversity in Medical School?

The AAMC recently published a piece about racial, socioeconomic, and gender diversity in 2023-4 medical school classes. The good news is that there's some more representation of those from Latino and Native American backgrounds. 

African-American student enrollment remained mostly stable.

Women matriculants rose slightly to 56.6%. Economic diversity was still a problem. See the article here for details.

Interestingly, those who entered medical school in 2023-4 had a median undergraduate GPA of 3.84, which was even higher than in previous years.