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
December 14, l983
Dear Sanford J. Brown
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
Do you have to open
animals in medical school? I can't stand that. It's
Do you have to listen to
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.
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
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?
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
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
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
Math I: 790
Math II: 80
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
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
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
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
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
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
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