Medical School and Residency Admissions: It's Not Personal

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn't personal. He likened the situation to Boston traffic - how drivers lean on their horns simply because they are frustrated about their days.

It's not personal, he said.

I say the same to those I mentor. Applicants get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix candidates up with one another; some turn up wholly unprepared - reading applicants' AMCASes or ERASes for the first time during the interview itself. 

Remember: It's not personal. This process is arduous and cruel, and most candidates, faculty, and program coordinators are tired and doing their best in a dysfunctional system.

Going to Medical School at Age 30+

According to the American Association of Medical Colleges (AAMC), approximately 3.5% of this year's matriculants to medical school are entering at 30+ years old. I was in my early twenties when I started, and there was a definitive difference in maturity and composure between the "older" students in the class and the rest of us.

Traditionally, some medical schools have been reluctant to train older students, as they see their career longevity truncated compared to younger pupils', however, with increasing demand for physicians and burnout that may shorten younger doctors' careers anyway, some schools are now more open-minded.

Here is a piece from the AAMC about folks who start medical school later.

Three-Year Medical School?

Ezekiel Emmanuel recently wrote a piece in the New York Times with two collaborators arguing the benefits of changing medical school to three years from four. The primary point was financial: Starting next year, under the "One Big Beautiful Bill Act," federal student loans for those in professional graduate programs will be capped at $50,000 per year. Grad PLUS loans will be eliminated completely, leaving half of medical students in the lurch.

Dr. Emmanuel and his collaborators point out that most medical students now arrive with upper-level academic background in sciences and that fourth-year medical school is almost like a "gap year." While I hesitate to agree with those two points, I do think he and his colleagues make other reasonable assertions: For example, making medical school harder to pay for will lead to fewer students from rural backgrounds and therefore fewer future physicians who will work in those needy areas.

Take a look at the piece here.

Reciprocal Liking

When I was at Harvard, we interviewed a residency applicant about whom I was enthusiastic, but when we sat down to talk about the candidate’s credentials, one of my colleagues put the kibosh on the applicant’s prospects. As it turned out, the candidate had made it clear (at least in my colleague's eyes) that he did not want to leave California. “If he’s not interested in us, why should we be interested in him?” my colleague asked.

Although you hope institutions will like you, keep in mind that institutions want to see that you are serious about them as well. 

There is a psychological principle called Reciprocal Liking: People tend to have positive feelings for those whom they perceive have positive feelings for them. Apply Reciprocal Liking to institutions when you interview. Be so familiar with the school/program that you implicitly convey you are excited and sincere about spending the next several years there. Know details about the institutional priorities, extra clinical opportunities, location, and associated hospitals. Make sure to have specific questions for your interviewer, ones that demonstrate your intimate knowledge of the institution and your belief that you could be a contributor and leader.

A Great Opportunity for College Premeds

Applications for the Summer Healthcare Professionals Education Program (SHPEP), a Robert Wood Johnson funded opportunity for college students interested in healthcare professions, open on November 1. SHPEP specifically targets students from economically or educationally disadvantaged backgrounds and those with demonstrated interest in issues affecting underserved populations. The goal is to help college freshmen, sophomores, and juniors apply and matriculate successfully to health professions schools. SHPEP is housed at 10 universities across the country with different start dates – all over the summer. Housing, meals, stipend, and travel expenses are all paid.

Take a look at the program's FAQ page here. The application deadline is February 5.

Check Out the AAMC Virtual Medical School Fair

The AAMC (Association of American Medical Colleges) will be holding a live informational fair Wednesday, October 29 and Thursday, October 30. There will be sessions with staff from medical schools, postbac programs, and the AAMC. 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 for pre-meds and candidates applying to postbaccalaureate programs, but there's no downside to hearing more general tips from the AAMC itself.

Making Medical School Tuition-Free is Not Encouraging More Doctors to Enter Primary Care Fields

In 2018, when Kenneth and Elaine Langone generously donated $100 million so students could attend NYU Medical School tuition-free, the philanthropists' main goal was to encourage more graduating physicians to enter primary care fields.

However, by 2024, the number of NYU graduating medical students who went into primary care was about the same as it was in 2017. Furthermore, in the interim, the number of African-American students had declined – although the number of Latinos had grown slightly. Additionally, at least in the first two years of the experiment, the percentage of incoming matriculants categorized as "financially disadvantaged" had fallen from 12% to 3%. One thing that had improved was NYU's rankings and reputation. (See this well-written Atlantic article by Rose Horowitch for a deeper dive into the query.)

Last year Hackensack Meridian School of Medicine in New Jersey launched a Primary Care Scholars Program to tweak the calculus. After being admitted, medical students may apply to the program if they commit to pediatrics, family medicine, general internal medicine, or geriatrics. The program covers a 50% tuition scholarship during the three-year MD track, $7500 as a relocation grant, and $2500 monthly for living expenses. The medical school plans to offer 15 spots next year. Here's a piece on the program and its potential future expansion.

I Highly Recommend this Paid, Summer Opportunity

I was an American Association for the Advancement of Science (AAAS) Mass Media Science Fellow in 1995 (during medical school). The program was truly fantastic and life-altering.

Applications for this year's fellowship are already open and will remain so through January 1, 2026. The scholarship is a 10-week summer program that places science, engineering, and math undergraduate and graduate students at media organizations across the nation - outlets like NPR, the Los Angeles Times, and WIRED. I worked at the Oregonian in Portland and had a tremendous time, learning how to write effectively and edit. I also gained an appreciation for the immense public health influence journalists can have. 

Here are the anticipated dates for this cycle:
Application window: October 1, 2025 - January 1, 2026
Fellowship: June 3, 2026 - August 18, 2026
Orientation in DC: June 3 - 5, 2026
Dates onsite: June 8 - August 14, 2026
Wrap-up in DC: August 17 - 18, 2026

Steep Fees for H-1B Visas Would be Devastating for International Medical Graduates, the Healthcare Profession, and Patients as a Whole

The US administration recently implemented a $100,000 fee for initial applications for H-1B visas – to be paid by prospective employers. The American Medical Association is lobbying for an exemption for doctors. Currently, new physicians from international locations represent one in six medical residents and fellows at US teaching hospitals, approximately 15,500 doctors in 2024. See this piece by Roni Caryn Rabin from the New York Times that covers the panic about and resistance to the policy's application to physicians and nurses. 

The Number One Strategy for Crushing Medical School and Residency Interviews

 Google had a problem. As a 2012 New York Times article described it, Google executives were growing increasingly aware that they were not hiring enough women. Worse still, they were attracting negative attention about it. So, Google did what Google does best: They amassed data and mined it.

In their analysis, among other findings, Google concluded that the company was overlooking women who tended to be more modest than comparable male applicants during interviews. The interviewers inappropriately perceived the women applicants to be less accomplished, and the candidates were not offered jobs. (Once they understood the problem, Google reported that they altered their internal hiring policies, accordingly.) 

No matter what your gender, the story is instructive in understanding how to strategically approach your medical school or residency interview: I call it, Let Your Story Show Your Glory.

Let’s start with this overarching strategy, one that can be gleaned from the Google story: The interview process is a persuasive one. Your role is to convince medical schools or program directors you deserve a slot at their institutions. The best way to persuade is with facts, just like a lawyer does when s/he is trying a case in front of a judge. Saying you are compassionate or hardworking is not convincing, and it doesn’t distinguish you from the scores of other candidates the interviewer is meeting. You need to prove your worth by highlighting your academic, clinical, research, community service, leadership, international, and teaching achievements.

When mentoring applicants, I hear them ask: Michelle, if I showcase my accomplishments in my interview, doesn’t that mean I’m being redundant? My answer: Absolutely! Think of the medical admissions process like building a house. Your AMCAS/ERAS/ResidencyCAS and letters serve as one layer of that house – like scaffolding. In other words, your accomplishments are conveyed simply and succinctly there. The personal statement is your opportunity to apply a thicker layer, one in which you flesh out your achievements, thus persuading the reader of your distinctiveness (plumbing, pipes, electrical). Finally, the interview is your chance to add on the thickest peel (exterior, roof).

Discussing your accomplishments in detail can seal the interviewer’s positive impression of you. 
If you still feel shy about drawing attention to your achievements, I can assure you that, occasionally, interviewers do not leave adequate time to review materials for the candidates they will ultimately judge, or they are asked to interview such a large number of applicants that they might understandably get candidates confused. If you treat every interview as though it were a “blind” one, you address these obstacles. Determine in advance how you want your interviewers to remember you when they represent you to the committee, and tailor your interview to leave that impression. At the end of the week, when your interviewer asks what others thought of the "young woman who volunteered with Mother Teresa while doing malaria research and competitive hammer-throwing," all the other admissions officers will know immediately she is referring to you.

Remember: You can say you are smart or caring or that you want to heal the world, but to admissions committees and program directors, who you are is what you’ve done...and what traits and skills you’ve honed accordingly.

[A version of this blog was previously published on the Varsity Tutors website, where I was part of their Admissions Expert Series.]