The Risk Involved in Going to Medical School (and How You Can Subvert It)

Risk Medical School

Most people wouldn’t normally think of medical school as a risky investment. Sure, there are risks involved when you become a practicing doctor, but going to medical school has always been considered one of the more “for sure” things, especially in getting that first job right out of school, the residency spot. Despite what many students may have been told, the risk of failing to make medical school a success venture, without dropping out or being dismissed, is slightly increasing and will likely increase more in the future unless changes are made. One should consider that possibility in their future before deciding to embark on a four-year journey that will test their emotions, patience, sanity, and their wallets. Furthermore, residency spots are largely funded by the federal government. Hence, the situation is out of the control of the students, faculties, and administrators at every school, and this additional element makes the situation somewhat less predictable.

The Match

“The Match” is the process that all medical school seniors and re-applicants go through each year beginning in late summer that determines the residency a student gets into and the type of medicine students will practice in their careers. Without residency training, a newly graduating physician is extremely unlikely ever to be able to practice medicine/acquire board certification.

The number of medical graduates in the US and foreign medical graduates (FMGs) who apply to US residencies is increasing. However, the number of residency spots remains stagnant or grows at a meager rate. The results of The Match compiled on the National Resident Matching Program site for years 2010-2015 show increases in the number of students who didn’t match. Although the increases have been small thus far, it shows a general upward trend. Many believe these increases will be larger in the future since new medical schools are opening and current schools are boosting enrollment. The larger influx of medical students is likely to worsen the bottleneck at the residency stage several years down the road.

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Credit: Bloomberg Business

An article published in Bloomberg Business reported that the number of deans of medical schools worried about the lack of residencies spots in the future is increasing: 87% of deans are worried about the worsening availability of residency spots for medical graduates. Given that administrators at medical schools have their fingers on the profession’s pulse, it does look rather worrisome, so many deans are concerned about the crucial residency prospects of their students.

However, the above graph doesn’t compare the match success rate between US graduates and FMGs. US graduates enjoy a much higher match success rate compared to FMGs. For example, according to the Educational Commission for Foreign Medical Graduates (ECFMG), only 49.5% of all FMGs participating in the Match of 2014 were successful compared to 94% of US graduates in the same year. This shows how good the likelihood of matching for a US graduate still is.

What to Do?

So, how can you mitigate this risk before and during medical school? Your actions will depend on whether you’re already in medical school or are pre-med. In either scenario, you should strengthen your resume as much as you can, and as soon as you can. For pre-meds, don’t wait until you’re in medical school to really be immersed in medical education and medical practice if you’re still leaning that way. For medical students, start your very first semester of medical school or right away!

Pre-Medical Students

The chances are likely that you haven’t heard of The Match and aren’t familiar with how residency matching works. Even though this information may have you a bit worried, you should keep in mind that your chances to match will still be good for quite a few years to come. However, to reduce your risk for not matching regardless of what the environment will be like while in medical school, you should take steps as soon as possible to make yourself stand out. Below is a shortlist of things you can do while in undergraduate to strengthen your residency application.

  1. Publish – You have more time as an undergraduate than you will as a medical student. Take advantage of that time now, and try to work with a medical scientist or a physician and try to get something to press. Publishing early also helps your application to medical school and takes the pressure off later when you are a medical student. Anything helps, even a poster presentation.
  2. Log Those Hours – You will be doing this for your medical school application anyways, but try to get more out of it and not just more hours. Stamping visitor’s passes and working the register in the gift shop (both jobs I have done) are not really invigorating ways to experience medicine. Try to shadow a physician in the hospital or clinic and get real patient experience. As a sophomore in college, I was regularly taking manual blood pressure readings, conducting initial patient interviews, and practicing obtaining blood samples, skills that proved infinitely useful once I entered medical school. Residency directors are more willing to hire someone who is as ready as possible to succeed. Plus, knowing physicians and working under them for a while may land you all the right letters of recommendation, crucially important if you’re planning to pursue the likes of dermatology or radiology.
  3. Read, Read, Read – Definitely read textbooks for your classes to get fantastic grades, but also read publications regarding medicine and your intended specialty, if you have one. Residency programs love to ask you insightful questions about the field, and the more background information you have read, the better your answers will be. Not only will it help you for residency, but likely you’ll have to face some similar questions during medical school interviews.

Medical Students

You’re in medical school! Congratulations! Unfortunately, you have less time to mitigate your risk, but you can still do things to make you stand out during medical school.

  1. Clinical Experience – Now that you’re committed to becoming a physician, you must get as much exposure as you can. This will help you shine during rotations and help you decide which specialty you may want to pursue. If you can, shadow a physician at the same site you would like to apply for residency. I shadowed several physicians at the hospital where I am now, and it made for a much easier interview experience later on. If not, local clinics that are affiliated with the school would likely be a good source. Anything that can add valuable hours and contacts to your resume is a fantastic idea.
  2. Leadership – You can demonstrate your ability to lead in various ways—student government, on-campus organizations, etc. In my experience, you get the most value for your time if you can participate in higher leadership positions in your school or participate in leadership roles with a third-party, independent organization. On-campus and student life organizations are good, but many students have this experience on their resumes since leadership positions aren’t as difficult to obtain.
  3. Publications – According to several residents interviewed for this article, publications and presentations are critical on your application since they demonstrate your ability to be a lifelong learner. Peer-review articles are the most coveted, but posters, presentations, talks, etc. are all helpful ways to strengthen your candidacy for residency. During an interview process, the topic of research and publication does come up, and your experiences can help make the overall outcome of your interview more positive.
  4. Keep up with the field – Maintaining your finger on the pulse of the field is important. Physicians are looked at to lead in many situations. To lead, you must be up-to-date on critical issues affecting medicine and the delivery of medical care. The trend with medical schools and residencies is to look for candidates who are not only smart but also resourceful. We talked to residents who do not doubt that this is already one of the most critical factors in obtaining a residency spot at most hospitals.

It is vitally important that you don’t just pursue the itemized list above. You should also pursue what interests you since it will make who you are stand out the most! The risk of not obtaining a residency is indeed growing, but your prospects are still very, very good, so don’t fret just yet. Further, the extra things you do to stand out as a candidate for residency may very well add more variety to your medical journey that you didn’t anticipate before. Medical school is stressful, and the journey is arduous in many ways, so it’s easy to fixate on the grades and the exam scores. Pursuing other things to strengthen your application may also help you forget about the stresses of applying to medical schools, taking the USMLE Steps 1-3, and applying to residency, even if just for a moment and allow you to realize that you’re currently doing and will continue to do wonderful things.

Updated October 13, 2020 to correct minor spelling and grammar errors.

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AJ Nguyen is a family medicine physician practicing in California. Dr. Nguyen's interests include academic medicine, preventative care, and healthcare education and leadership.   AJ Nguyen is a family medicine physician practicing in California. Dr. Nguyen's interests include academic medicine, preventative care, and healthcare...