The Road to Medical School

1. The Road to Medical School Dr. David Frank Chemistry Department CSU Fresno McLane 159 (278-2273; email is better) davidf@csufresno.edu

2. 11th Annual UC Davis Pre-Medical & Pre-Health Professions National Conference: “Passion for Life, Education, Service, and YOUR Future in Healthcare” Saturday & Sunday October 12-13, 2013 8:00am-6:00pm University of California at Davis, Pavilion For Bundle (Bus, Food, Lodging) contact Cristian Sarabia cristiansinaloa@mail.fresnostate.edu

4. Malpractice Insurance • Cost depends on the state & location • Internal Medicine: $6K - $11K/year • OB/GYN: $55K/year (2009) • General Surgeons: $28K - $55K/year • Physician Assistant: $2K –$6K/year

5. Financing Physician Education • The median education debt for indebted medical school graduates in 2012 was $170,000, and 86 percent of graduates report having education debt • Debt: Public: $160K, Private: $190K • Cost: Public: $197K, Private: $275K • Scholarships (4 yr): Public: $14K, Private: $30K • Remember you need a good credit score to qualify for many loans.

6. Academic Medicine, Jan. 2013: Study shows that recent medical school graduates with the median amount of education debt ($160K-$170K) can enter primary care, raise a family, live in an expensive urban area, and repay their debt within 10 years without incurring additional debt. However, heavily indebted primary care graduates (who owe $250K+) must plan repayment and lifestyle choices carefully and strategically. The article includes debt repayment models across a variety of scenarios and specialties. It suggests that education debt need not play a determining role in specialty choice and illustrates the capacity of physicians to repay their education debt.

7. Bachelor Degree Possibly Post-bac work to shore up soft GPA Medical School - 4 years Residency - Minimum of 3 years (1st year often called internship) Optional: Fellowships for further specialization The Path to Becoming a Physician

8. Academics - Required Courses, Bachelor’s Degree Extracurricular Activities (including medical experience) MCAT Research Letters of Recommendation Finances for the Application Process Have A Plan Diploma

9. www.csufresno.edu/premed www.fresnostate.edu/premed

10. What Should I Major In? • Whatever interests you the most, BUT... • English, philosophy, history, music majors, etc. may take longer to graduate to get all of the pre-reqs, cannot get grants for units outside of their major, and the science GPA is vulnerable. • Advantages of Biology or Chemistry major • Premed prereqs are part of the degree requirements-grants & scholarships can only cover units of MAJOR • Science (BCMP) GPA is buffered by taking more science classes • Better preparation for first year of med school • Higher priority at getting into impacted first year Chem 1A/1B and Biol 1A/1B.

11. Undergraduate Academic Preparation • 1 year of General Chemistry (1A and 1B), even if you have AP credit. NOT 3A/3B • 1 year of Organic Chemistry with lab 128 A & 129A, then 128B and 129B) • 1 year of General Biology with lab (Biol 1A and 1B), even if you have AP credit. NOT Biol 10 • 1 year of physics with lab (Phys 2A/B; Does not have to be physics for physics majors). • Math 75 and Math 101 (Statistical Methods; 4 units)

12. In general we advise pre-med students to take general chemistry and biology at Fresno State (not a community college) even if they have AP credit for these courses. However, you can check with the medical schools in which you are interested to find out about their policy on AP courses. The medical school might allow an upper division course in the particular discipline to fulfill the requirement. Hard to know early on which med schools you will choose to apply to… AP Credit

13. 1 year of EnglishUpper division with lots of reading, critical thinking, and writing; or Philosophy courses 1 year of Math (calculus, statistics, computer science) 1 semester of Biochemistry Academics - Courses Required by Many Medical Schools(and really important for the MCAT)

14. • Physiology (Comparative or Human; can help with the MCAT) Genetics (can help with the MCAT) Human Anatomy (just before entering; can help with first year med school) Cell Biology & Molecular Biology (can help with first year med school) Academics – Other Courses

15. Academics – Other Courses Because the the MCAT in 2015 will change, we strongly advise students who may take this exam to take… • One or two semesters in introductory psychology -PSYCH 10. Introduction to Psychology (3 units) -PSYCH 40T. Topics in Research Design and Statistics • One or two semesters in introductory sociology -SOC 1 or 1S. Principles of Sociology (3-3 units) -SOC 3. Critical Thinking about Society (3 units) • Introductory Biochemistry: Chem 150

16. Before applying, make sure that you have fulfilled the course requirements for the medical schools to which you intend to apply.

17. Aim for a minimum 3.6 GPA, for BOTH your overall GPA as well as your BCMP (Biology, chemistry, math and physics) GPAs. For allopathic medical schools, the GPA is calculated based on all courses taken, even those for which you applied for grade substitution. Academics Count

18. www.aamc.org/msar

19. Stanford = Irvine = Upper Division Biology Statistics

20. Nationwide: 20,518 seats and 46,454 appicants: 44%

21. Schools with multiple CSUF accepytances 2011-2013 32 other schools have accepted one CSUF student in this 3 year period.

22. 2013 Data # of Applicants 26:48% - 20518: 44% GPA MCAT

23. 2013 Data 44 CSUF students applied, 20 were admitted to at least 1 school: 45% acceptance rate. Highest MCAT with acceptance: 39R Lowest MCAT with acceptance: 23Q Highest GPA: 4.0 Lowest GPA: 3.57

24. What is Osteopathic Medicine? • Critical physician workforce shortage. By 2020, the gap between our physician supply and demand = 50,000 to 100,000+. • > 4,200 new osteopathic physicians/yr enter the workforce. • > 63,000 fully licensed osteopathic physicians practice the entire scope of modern medicine, bringing a patient-centered, holistic, hands-on approach to diagnosing and treating illness and injury. • > 20% of US medical students -> osteopathic physicians. • DOs can try for any specialty, prescribe drugs, perform surgeries, and practice medicine anywhere in US. • Osteopathic manipulative techniques to diagnose and treat patients. • Osteopathic physicians work in partnership with patients to help them achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention.

25. Osteopathic Medical Colleges AACOM.ORG There are currently 29 colleges of osteopathic medicine, offering instruction at 37 locations in 28 states. Twenty-three of the COMs are private; six are public. Western University of Health Sciences College of Osteopathic Medicine of the Pacific (Pomona, CA) Candidates for admission must have a minimum science GPA of 3.30, a minimum overall GPA of 3.30, and a minimum average MCAT score of 27.

26. What is a Physician Assistant? A physician assistant (PA) is a medical professional who works as part of a team with a doctor. A PA is a graduate of an accredited PA educational program who is nationally certified and state-licensed to practice medicine with the supervision of a physician. What can PAs do? PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice and prescribe medications.

27. Prereqs for Physician Assistant Program - Tuoro • 8 semester/12 quarter units (including labs) in each of the following categories: • Biological Sciences (may be comprised of general biology, genetics, immunology, embryology, etc.) • Chemistry (may be comprised of inorganic, organic, biochemistry) • 4 semester/5 quarter units (including labs) of the following: • Human Anatomy (must be completed within 5 years of expected year of matriculation) • Human Physiology (must be completed within 5 years of expected year of matriculation) • Microbiology • Statistics (3 semester/5 quarter units) • All pre-requisite courses must be completed with a “C” or better

28. Clinical Experience - Tuoro Candidates must have obtained a minimum of 500 hours of health care/clinical experience, either as a volunteer or in a paid position.  Competitive candidates, however, will have obtained 1,000 or greater healthcare hours. Evaluation Criteria for Clinical Experience Total number of hours Setting Specific duties performed and/or skills acquired Description of the duties Patient population served Level of supervision Time frame of the experience 

29. Prereqs for Physician Assistant Program - SJVC • General Chemistry (with lab) • General Microbiology (with lab) • Human Physiology (with lab) • Human Anatomy (with lab) • Public Speaking or Oral Communication • Intro to Sociology or Cultural Anthropology • Reading and Composition • General Psychology • College algebra or higher* 2,000 hours of direct patient care experience is also required for admission (paid and volunteer hours are acceptable). Hours accrued as a student in a training program cannot be used towards this total.

30. Some “Pros” for a PA Career • Requirements for admission to PA school easier than med school • PA school is only 2 years: need not acquire huge student debt. • You can easily switch specialties without lengthy schooling & residencies • Work fewer hours and time off is really “off”(?) • Malpractice insurance less costly: $2K – 6K/year

31. Some “Cons” to a PA Career • If you have a “leadership” personality and would prefer to give orders rather than take them, PA may not be right for you. • PA salaries are capped and less than a doctor’s. • Less status as a PA than as a doctor.

32. Three Multiple choice parts: Verbal Comprehension Physical Sciences Biological Sciences Writing Sample is gone in 2013 Be sure that you have completed all the coursework required Take practice exams. Scores on these will determine whether you are ready to take the real one. These are available for only $35 each, after the first free one, from AAMC. The “Old” MCAT (Before 2015)

33. Natural Sciences: concepts in biology, general and organic chemistry, biochemistry, and physics Psychological, Social and Biological Foundations of Behavior: Concepts of introductory psychology and sociology, and introductory biology concepts that relate to mental processes and behavior. The “New” MCAT (Begins 2015)

34. Critical Analysis and Reasoning Skills: be able to analyze, evaluate, and apply information provided by passages from a wide range of social sciences and humanities disciplines. Does not test specific knowledge Does test the skills in analysis and reasoning that you need for medical school may prompt you to read broadly as you prepare Along with many others, passages about ethics and philosophy, cross-cultural studies and population health are included. The “New” MCAT (Begins 2015)

35. The “New” MCAT (Begins 2015) https://www.aamc.org/students/applying/mcat/mcat2015/

37. The best timing is to take the MCAT in the spring* of the calendar year prior to the year you plan to enter. (For most this will be April of their junior year.) However, do not take the MCAT before you are ready. *APPLY EARLY, SEATS SELL OUT. The MCAT is now offered on-line on 24 different days during the year. The exam is now a 7 hour test;. There is a test site in Fresno. Register early to be sure you get the date and site you want. Go to the AAMC website for informationand registration. MCAT Timing

38. While taking chemistry, biology and physics, remember you are preparing for the MCAT. Check the AAMC website and consult The Official Guide to the MCAT Exam available from AAMC For MCAT2015, visit https://www.aamc.org/students/applying/mcat/mcat2015/ Remember to schedule in preparation time before taking the MCAT. Consider the Kaplan prep course ($2000). Don’t ever take the MCAT for practice: it’s expensive ($270). Plan to take it only once. MCAT Preparation

39. MCAT Preparation Change your high school study habits: • Rote memorization doesn’t work so well for the MCAT. • You need to develop conceptual thinking skills. • Start making notes from your text as well as lectures. • Organize the material by topic. • Look for logical connections between all of the facts, don't just memorize isolated facts. • Read and review notes for understanding. • This all takes TIME (2-3 hours of study for each hour in class) • Recommend Engl 101, 102, 103 for reading comprehension & critical thinking

41. There are lots of summer opportunities for students interested in being physicians. Check the internet, the AAMC and the aspiringdocs & our websites. Applications are due between January and March and are extensive. Look into programs early. What Do I Do In The Summer?

42. Medical Experience Leadership Volunteer Service Research Extracurricular Activities

43. Keep track of your extracurricular activities and the hours you devote. You might want to keep a journal of clinical experience to record your experiences and maturation: its good material for that personal statement. Keep Good Notes

44. Two science faculty, one non-science faculty, and one or two others Remember while taking courses that you are going to need letters of recommendation. Doing research with a professor helps him/her get to know you and write a more credible letter. Have the letters on file the spring semester before you apply (April/May of junior year). Letters Of Reference

45. Most med schools use the AMCAS letter distribution service. They only accept letters from AMCAS. You must provide each letter writer with your AMCAS Letter ID found on your AMCAS Letter Request Form, as well as your AAMC ID#. Letters Of Reference

46. Instruct the letter writer to either send your letter to AMCAS directly, or to Ms. El-Bendary in the Information Center (S1-136). In either case, the letter must be accompanied with your AMCAS Letter Request Form, as well as your AAMC ID#. We shall send your letters to AMCAS on your instruction. If all are being sent to the same schools, they can be sent as a packet with the same Letter ID #. Advantages of our service: we keep copies of your letters which may be needed for scholarship applications, for non-AMCAS schools, and for AACOM applications. Letters Of Reference

47. Primary Application - takes time! transcripts from all college-level schools personal statement record of extracurricular activities names of letter of recommendation writers for those medical schools that use the AMCAS service for collecting letters of recommendation Secondary Applications more essays request letters of recommendation be sent to AMCAS, the MD application service*. (Letters to AMCAS can be sent after the primary application is submitted.) *unless school is not using the AMCAS letter distribution service. The Application Process

48. Secondary Application Institution 1 What is your interest in XYZ School of Medicine? Insitution 2 Describe your motivation to become a physician. What do you see as the most significant issue the medical profession will face in the next 40 years? What personal benefits have you gained from your major extracurricular activity? What personal benefits have you gained from your research/teaching experience? Given the opportunity to share dinner conversation with one person (deceased or alive) who has made a significant contribution to science, medicine or human service, identify the individual you would select and why?

49. Institution 3 • Please explain your reasons for applying to XYZ School of Medicine. We understand that you are probably applying to several medical schools. We are interested in why you have placed XYZ School of Medicine on your list of schools. (max character limit 1500) • Please describe any unique characteristics you have that will contribute to the diversity and bring educational benefits to the entering class. (max character limit 1500) • If you are not in a degree-seeking program, please indicate what you will be doing from the time you complete this application to the start of medical school.

50. Choose medical schools carefully. Know what they offer and what you offer them. Review your application and their catalog and mission statement. Talk to medical students. Find out about hospital affiliations, curriculum, student support. If possible, engage in a mock interview. The Interview