by Sanford J. Brown M.D.



You can get into medical scool COVER


The Birth of Premed Consciousness

Of all the letters I have received over the years from aspiring premeds I reserve a special place for those from my young readers. These people are not concerned with the ins and outs of getting into medical school because they are not yet committed to that path. Their questions are more personal; what's it like being a physician, what's it like being a medical student, and how will it change my life? There is an ingenuous quality to their letters which I find touching, and also a minor sense of urgency. It's almost as if they're saying, "Look, I have these ideas about what the medical profession might be like. Are they accurate or misconceptions? Please tell me quickly so I can go about planning for my future."

Here are two letters that may remind you of some questions you have had, or may still have, about a medical career:

December 14, l983


Dear Sanford J. Brown M.D.,

Hi, My name is Debbie Higgins. I am 13 yrs. old. I want to be a doctor when I get older. I would like to ask you some questions. Well, a little more than some.

Is it hard getting into a school of medicine?

Do you have to get good grades in science? Most of the time I get Cs but this semester I got an A in physical science. I don't want it to sound like I'm bragging, but will it help me?

Will being a candystriper help?

Do you have to open animals in medical school? I can't stand that. It's gross.

Do you have to listen to long lectures?

Do you have enough time for a personal life- boyfriend, dates, a partime night job like a waitress-and time for studying too?

Please answer my questions- they're important to me. Thank you.

Debbie Higgins

Dear Debbie,

I was delighted to get your letter. I must say, I don't get much mail from 13-year-olds interested in pursuing a medical career. But it's not too early to start. You're on the right track.

Most of your questions I believe are fully answered in my book, Getting into Medical School, now in its sixth edition. It's published by Barron's Educational Series and you should have no trouble obtaining it.

Some of your questions are not mentioned in the book. For one, dissection is required in medical school. Ironically, the course that requires it is called "gross" anatomy. Cadavers, rather than animals, are opened and studied. It's helpful to an understanding of how the human body works. I'm sure that, if you attend medical school, you'll take it in stride.

Rest assured that medical school will leave you sufficient time for a personal life. Nowadays even married women with children attend, so having a boyfriend and part-time job should be no obstacle. Maybe you can have your boyfriend get the part-time job, leaving you more time for your studies.

Good luck in your quest.

Sandy Brown, M.D.

February 20, 1980

Dear Dr. Brown:

I am writing to you not about getting into medical school, but about the medical field.

I am 17 years old and I have been interested in medicine for a long time. I get As and Bs in school and I am a hard worker. I have always gotten good grades in science and I believe I have the dedication to get me through medical school.

However some things bother me, like the idea that while I would be helping someone, they'd be screaming in pain. To let you get the picture I am enclosing some pictures from this month's Life magazine (a photoessay about burn patients). Quite frankly, this stuff grosses me out. What I want to know is if this bothers me now, should I switch my career plans? Is it unusual for people interested in medicine at my age to get "grossed out?" (I don't know anyone my age interested in medicine). Seeing things sticking out of a punctured eye doesn't appeal to me either. Do I have to turn my stomach into cast iron?

I don't know if I'm barking down the wrong alley. I feel I could be a good doctor except for a few hang-Lips. I put in a hundred hours at our county hospital as a volunteer and not much bothered me. Child abuse bugs me too: is this something you learn to live with? Yuk.


Bill Levine

Dear Bill,

Quite frankly, your picture grossed me out too, and I think if I were 17, I would question a career if I thought that it might mean inflicting pain on someone. However, as you will learn if you study medicine, there is a class of drugs known as opiates that are effective, if used in proper strength, in alleviating physical pain. Perhaps you have never hurt enough to require a shot of morphine or demerol, but should you ever, (and of course I hope you never do) you will discover how truly potent these medicines are and how important for people in pain.

It may be that the boy in the picture has been undermedicated for the procedure he is undergoing. You also have to remember that having a bad burn is probably the worst thing that can happen to someone short of dying. Taking care of these patients is something few physicians do. It is specialized work done in special centers.

I must admit that in my six years of practicing medicine I have never seen something sticking out of someone's eye, although I take foreign bodies like filings or sawdust out of eyes routinely. I have seen several abused children.

I would be less than truthful if I didn't say that you learn to live with a lot, but that's partly why you go to medical school. Sometimes you can t help someone if your stomach's turning inside out. In medicine, as with water, everyone finds their own level; if you're too sensitive for some types of medical practice, you will find your niche in another.

I do appreciate your letter, Bill. Your concerns are very real. Getting grossed out from the Life magazine picture is a healthy response. I hope you keep your sensitivity.
Sandy Brown, M.D.

Many high school students are already strongly motivated to become physicians and they are thinking ahead to college and beyond. The following two letters are illustrative:

November 14, 1979
Dear Dr. Brown:

I am a high school senior who is considering medicine as a career. Despite the information supplied in your book there are still two questions to which I would greatly appreciate a personal answer.
The first deals with the old question of should I go to the most prestigious college I can get into or to a less prestigious school where my marks may be higher. Let me give you some academic information that might help you:

My SATs:  Math: 760  Verbal: 650
Achievement tests:
Math I:             790
Math II:            80
Chem:               710
Biology:            720
I graduated 20th in a class of 559


If I got in, should I choose Johns Hopkins, the University of Pennsylvania, M.I.T. or Brown over less prestigious schools such as Brandeis or the University of Rochester? How much weight does the college I attend have on my chances of acceptance to medical school?

A second question is, should I necessarily major in a science? I am considering majoring in economics, so that if I decide not to go into medicine, or I am not accepted, I will have something to fall back on as a career. Will this have an adverse affect on my chances of acceptance?
I realize that these are hard questions to generalize on, but I would be appreciative of any advice that you can offer.

Glenn Devine

Mr. Devine clearly does not have the problems most of us have when worrying about how we're going to get into medical school. Graduating in the top 5% of his class, with outstanding SAT scores, he is the type of student that the premed curriculum and MCAT are made for. His biggest problem will probably be deciding which medical school to attend. However, he can do himself a favor by choosing a college for reasons other than prestige or ease of getting good grades. He should go to the school he feels best about and get a well-rounded education. Medical school admissions committees have rejected applicants whose only achievements were high GPAs and MCAT scores. It is important to distinguish yourself in areas other than academics and, for borderline academic students, it is critical. (Of note-a personal communication that I received from Mr. Devine four years later states, "As possibly useful to you I offer the information that I most likely be entering Columbia P&S next fall." The letter was dated April 21, 1984 which would have made Glenn a college senior and, as I predicted, he did very well).

October 22, 1980

Dear Dr. Brown,

I am presently a junior at St. Mary's Academy, a high school for girls. I am very interested in becoming a physician. I am a candystriper at a nearby hospital and have talked to many doctors about their careers.

However, there are a few things I am worried about. I have read at least three articles which said there will be too many doctors by the year 1990. Also, I am worried about not getting into medical school.

Most of the doctors I talk to have said that if you really want to be a doctor, you can do it. I hope this is true, because I don t want my desire to become a doctor to be just a dream-I want to make it a reality.

Gail Piotrowsky

Ms. Piotrowsky chooses to worry about not getting into medical school but, should she succeed, she would then prefer to worry about the notorious expected surplus of physicians in the next decades. Well, I suspect that in some circumstances it is appropriate to put the cart before the horse; why go into a field that requires intense preparation if the job outlook is dismal? We are graduating many more physicians yearly now than we were ten years ago. The costs of medical education are high and most students graduate in debt. Furthermore, many medical and more surgical specialties are glutted, and physicians no longer have the luxury of making their living wherever they might wish. Physicians are struggling more than ever to become established.

What will all this mean down the road? Not, I suspect, that earning a livelihood as a physician will become impossible, but that it will require considerably more sacrifice. Young physicians will not be able to have their cake and eat it too, as in the past. They may have their choice of specialty or place of residence, but probably not both. And they will earn less money because there will be more of them competing for available patients. All this may have a salutary effect on the profession, encouraging those people primarily interested in public service and discouraging those whose primary motive for entering medicine is financial. I honestly cannot foresee the time when a young practitioner oriented toward patient care will not be able to live comfortably.

However, to be fair to the darker side, the solo practioner may become extinct in the next decades along with the physician's long-treasured autonomy. Increased competition and fiscal restraints will influence how physicians practice medicine. More physicians will be working for hospitals, health maintenance organizations and ambulatory care centers. Fewer patients will be admitted to hospitals, for shorter periods of time. As society in general becomes more cost and care conscious, health-care consumers will do more "doctor-shopping," seek second opinions and demand active participation in health-care decisions. We may well witness a paradox: on the one hand medical care could become rationed according to ability to pay for services; on the other, physicians and hospitals may arm themselves with business and marketing strategies to be competitive in an era of surplus health-care providers and facilities.

The most incisive article I have read about the projected physician supply in the United States is The Expanding Physician Supply and Health Policy: The Clouded Outlook, by Eli Ginzberg (see bibliography). Ginzberg, a longstanding health care economist, meticulously examines past and present health care policy with an eye to the 1990s. Included are thoughts on physician distribution and recruitment, the impact of women physicians, costs of medical care vs. supply, physician income and hours of work, and national health insurance. He also discusses medical education, from the applicant pool to residency training, and ends with a discussion on consensus and policy. This is highly recommended reading for anyone concerned with the economics of medical care




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