For patients, actually being patient can be the most difficult part of receiving healthcare. For some, this ends in the waiting room, but others, unfortunately, anxiously await insurance approval, test results, surgery, transplants, and sometimes—even death. The list of things patients wait for is long, just like the wait-times they endure before any given appointment.
However, in medicine, patients aren’t the only ones who need patience. It’s important that physicians learn to be patient as well; something that is much easier said than done for many type- “A” physicians in training. From the minute they submit applications to medical school, young doctors begin to learn patience and how it is a virtue.
Patience becomes much more of an essential asset during the medical school application process compared to most hopeful medical students’ past experiences. But what makes this so? Why is the medical school application process so frustrating? And does the process need to be this way?
In order to answer the question of why medical school admissions are so frustrating, and how patience becomes a necessity during an application cycle, it’s helpful to relive the glory days of applying to college. Remember applying to college? My high school used software that compared our SAT/GPA to the average statistics of each college we were considering applying to and indicated whether we had a fair chance or not. In this way, the software actually dictated where we should apply, based on our chance of acceptance. Why was it so easy to accurately predict one’s chances of being admitted to a given college? As we understood it, acceptance and rejection came down to simple statistics. If students had “stats” that exceeded the school’s 90th percentile, then they were practically guaranteed acceptance letters. Further, students with average stats for a given school along with a list of extracurricular activities were still likely to be admitted. On the other hand, students applying to colleges with stats in an average class’ 10th percentile were highly unlikely to receive an acceptance. It is this experience that often tricks aspiring premeds into thinking that the following equation, mirroring the college application process, rings true:
To the shock and frustration of many applicants, this equation does not adequately reflect reality. Medical school admission is an arduous and long process, much more complex than a simple equation, designed to select the absolute best individuals to become future physicians. Part of gaining acceptance therefore includes selection for applicants who are patient enough to endure this difficult, drawn out process.
The moment one decides to apply to medical school, one joins a competitive crowd. There are many hurdles that spring up on the path to submitting an application, “weeding out” many aspiring applicants at each obstacle. This process yields an application pool of highly competitive and passionate students.
For this reason, there is no expectation that every student applying to medical school will get in somewhere. In fact, acceptance rates at nearly all medical schools are lower than the most selective undergraduate colleges. This partially explains how the student with a seemingly perfect application is rejected and has no logic or insight as to why. Clearly premeds will not receive the same slew of acceptances they did when applying to undergraduate. Instead, applicants must learn to wait for one, or at most, a very limited number of acceptances— if they are fortunate.
Future students begin by filling out their AMCAS application, followed by school-specific secondary applications, a particularly time-consuming endeavor for applicants applying to more than a few schools. Many schools take weeks to months to send out secondaries, thereby drawing out the process. Additional delays are common. For instance, an admissions committee must first receive all application materials including letters of recommendation and transcripts, which are subject to the bureaucratic processes of undergraduate offices and busy professors, before the completed file is placed in line to be read.
Medical schools often operate by a rolling admissions process in which students may hear back any time within nine months of submitting their application. Therefore, a medical school applicant may hear back mere weeks to many months later that they were either granted an interview, were not granted an interview, or (everyone’s personal favorite) that the decision whether to give him/her an interview would be made later (on-hold). This means that students will subsequently have to wait days to months to interview and then even longer to hear a “final” admission decision, which may in fact be that no admission decision has been made yet.
But why exactly is use of a waitlist so important in medical school admissions? This is a question you personally may have wondered several times while struggling to be patient during your own medical school application experiences.
First off, medical schools cannot risk “overbooking” a class. Other types of colleges don’t need to avoid this nearly as much. In fact, it is not uncommon for undergraduate institutions to accept a certain number of applicants, and then be pleasantly surprised when a higher number of students matriculate than expected. Alternatively, medical schools cannot expand their class size so easily. A medical school cannot simply add patients to a hospital or affordably increase the number of highly trained physicians that are on-staff to provide one-on-one instruction to students. This means that instead of sending out a slew of acceptances to everyone that is qualified, medical colleges must take extra care not to overfill their classes. This becomes even more challenging when one considers how much smaller the average medical school class is. For instance, Dartmouth College’s undergraduate freshman class size is 1,116 whereas it’s medical school enrolled only 89 students last year. Suppose that Dartmouth underestimated the number of students that would attend out of the 5000+ applicants by just 2%. This would double their class size. For this reason, medical schools must have other methods of filling their classes that does not entail accepting students and waiting to see if they will attend.
Other than running out of space for students, what is the big deal if a class gets overbooked? Contrary to popular belief, medical schools actually lose money for every student they enroll. Why is this the case? Put simply, training doctors is expensive:
Reason #1: Medical schools must employ PhDs and MDs to do the bulk of the teaching. This comes at a steep price because salaries must compete with the salary an MD/PhD could make working in a hospital/lab.
Reason #2: Medical equipment is expensive. The fixed cost that an undergraduate university must endure to provide a classroom is meager compared to that of a medical school. The average medical school classroom generally consists of everything a college classroom has and must include expensive medical equipment.
Reason #3: The 3rd and 4th years of medical school consist of clinical rotations in which medical students work directly with patients and physicians. Most attending physicians would agree that they could be more productive if they did not have to concurrently teach medical students. If these physicians were not responsible for medical students and more efficient as suggested above, they would not only earn more for the hospital but also more for themselves. Economists would argue that in order to get physicians to agree to this you must compensate them somehow. Furthermore, malpractice insurance for pre-MDs is expensive, enough said.
Finally, one last issue with overbooking a class is that the most well-known medical school rankings base 10% of their ranking off of medical school acceptance rates. This means that the more students a school accepts, the worse their ranking will be .
CONVERSELY, medical schools CANNOT have “empty seats” in their class. Yet, as per the reasons stated previously, a shotgun approach to admitting students does not suffice. The current solution to this problem is the notorious waitlist. In fact some medical schools, like Jefferson Medical College, may take up to thirty-three percent of their class from the waitlist each cycle.
A key benefit of the waitlist is that it allows admissions committees to gauge applicant interest. If a medical school blindly accepted qualified applicants, then a large portion of the accepted applicants may not attend and the medical school’s “yield” (#matriculating students divided by the #accepted) would decrease, thereby worsening the school’s ranking. Waitlisted students that desire admission can show interest via various updates. This allows schools to accept the most qualified applicants that are the most likely to attend, improving yield while also matriculating the most qualified and passionate class possible. The waitlist is also beneficial because it provides the opportunity for students “on the line” between acceptance and rejection with time to strengthen their application.
Lastly, schools sometimes use waitlists as a softer way to let down rejected applicants. Evidence for this is that in some cases zero students are accepted from the waitlist. Indeed, it is rare for a student that interviews at a medical school to be outright rejected post-interview. These facts, plus the knowledge that some schools, some years, pull a large number of students off the waitlist makes evaluating the chance of gaining acceptance from the waitlist unpredictable. All of this is to say that med-school hopefuls must be prepared to be waitlisted at at least some of their schools. Indeed, in 2015-2016 the average number of schools applied to by each applicant was 12, yet the average acceptance rate was well below 10%.
Now that we have established why the waitlist is beneficial to medical schools, let's examine it from the applicant perspective. How does this frustrating process of high-stakes, drawn-out waiting with no guarantees impact applicants? Does this process help applicants develop patience as a virtue? Furthermore, does patience aid students who do matriculate in medical training and their future careers? And lastly, is there a more humane way to teach physicians in training patience?
One possible benefit is that the waiting process may make matriculated students more grateful for the spot they receive, subsequently motivating students to learn and view the rigors of a life in medicine as a gift. This outlook could be advantageous for students embarking on an arduous training process, followed by a demanding career. Moreover, perhaps such a process necessarily selects applicants with the dedication and perseverance to endure these waiting periods.
Further, patience is a crucial quality for time-pressed practicing physicians, as it is undoubtedly needed navigating the day-to-day complexities of the healthcare system. Patience becomes even more important interacting with patients, especially those experiencing hardships. These situations demand patient compassion: taking the time to listen, providing additional explanations, and giving patients the time to process their situations. In this way, patience becomes central to providing proper patient care and fostering intimacy in the doctor-patient relationship.
Alternatively, it is possible that to get to the point of application submission, aspiring pre-meds have previously been selected for patience. Subjecting applicants to excessive waiting during the application processes may be an unnecessary source of additional stress and anxiety for aspiring medical students. Stress and anxiety are not benign and are associated with significant social and physiological drawbacks that must be carefully considered before subjecting applicants to this process. For instance, applicants may avoid social environments for fear of needing to explain to their family and peers that they have been waitlisted.
Meanwhile, sustained stress has been linked to health problems such as increased blood pressure and gastrointestinal problems. Further, such stress early on in training may contribute to high burnout rates, career dissatisfaction, and high suicide rates observed among physicians and those in training.
For these reasons, would a different system without extensive, ambiguous waiting be a more humane and compassionate alternative to the current system? After all, if medical students are expected to be compassionate, shouldn’t the medical education system lead by example?
With all of this being said, I hope that you now have a better understanding of why the current admissions process requires so much patience. Further, I hope this article encourages you to reflect on the benefits and drawbacks of our current application process and how it could be improved while still matriculating high quality individuals that possess patience as a virtue. It is clear, you cannot become a doctor without patients. Nor can you become a good doctor without patience. While not a perfect system, by selecting for patience along with a slew of other qualities, medical schools hopefully matriculate students with the ability to treat patients with patience, guiding those we care for compassionately through the complexities of life and death.
About the Author
Josh Newman is a medical student in the Sidney Kimmel Medical College Class of 2019.
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