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Student, Interrupted

The New Physician January-February 2000
Getting into one medical school is difficult enough. Students forced by circumstance to
transfer and repeat the ordeal often face even tougher obstacles.

Alison Ambrose never wanted to split her education in medicine among two schools. Her two years at a mid-sized medical college in the Northeast had been happy ones, and she looked forward to completing her rotations at hospitals in the region. But when her fiancé found a good job in a city hundreds of miles away, Ambrose (not her real name) decided her commitment to her future husband outweighed any sense of obligation she felt to her medical school.

Her dean of students disagreed. The school she was trying to leave did not accept applications from transfer students, and they were no more eager to help someone find the exit. When Ambrose requested that her transcript and records be forwarded to another institution, her school demanded $500 for a service that most medical schools provide to students for free or at a nominal cost. Ambrose was stunned.

“I already paid $30,000 a year to go to school there,” she says. “I was at school on loans.” When Ambrose asked why the fee was so high, school officials were blunt: “They said, ‘We’re trying to deter students from doing this,’” Ambrose recalls. She protested, but ultimately chose to pay the fine rather than jeopardize her chances of admission at another school.

Fortunately, sympathetic professors stepped in and provided the recommendations Ambrose’s dean of students would not. After a four-week delay while she waited for her U.S. Medical Licensing Exam (USMLE) Step 1 scores to arrive, a school in the same Midwestern city as her future husband’s new workplace accepted Ambrose as a third-year student. She made friends quickly through her rotations, made up for her late start during her fourth-year vacation period, and yes, got married. Now in the midst of interviewing for residency, she has no regrets about her decision to transfer.

But Ambrose still fears the ire of her first school when she must again request transcripts or other documents, which is why she won’t allow the name of her old school to be published. And the number of students who transfer medical schools each year is small enough that to identify either her first school or the one she will graduate from in May would be to identify her.

Although Ambrose’s story may not be that of a typical transfer student in medical school, it isn’t an uncommon one, either. Several students contacted for this story refused to share their transfer experiences even under the protection of anonymity. Some cite the fear of reprisals from administrators at their former schools, while others simply say the experience was too personal, too painful or too wearying to talk about for publication.

These students are not alone in their reluctance to talk about transferring. The Association of American Medical Colleges (AAMC) says transfer admissions data are currently unavailable. But the organization’s Web site states that admissions officials should submit a form to the AAMC when they accept transfer students, and that the AAMC periodically distributes lists of all acceptances to medical school admissions officers around the country. Admissions officials at Brown University, Temple University and Baylor medical schools, among others, confirm that they regularly receive this list from the AAMC.

What is clear is that the number of medical students who transfer every year must be relatively small, given that no medical school contacted for this story reported granting more than 15 students “advanced standing” in any academic year, and most accepted fewer than five.

Most medical students who transfer appear to do so to remain close to a spouse or family member. In fact, most medical schools who consider transfers require applicants to show “hardship” or “a compelling reason” along with their transcript, recommendations and other materials.

As Audrey Uknis, assistant dean for admissions at the Temple University School of Medicine, puts it, “‘Hardship’ means we’ll entertain the transfer. Then we look at your grades and your scores.”

Nearly all schools that accept transfers share other requirements, too: The student must be in good standing at an accredited U.S. medical school. Most colleges allow students to transfer between years two and three only, although a handful of schools, such as Temple, permit transfers after the first year. Many allopathic schools won’t accept transfer applications from students at osteopathic schools. And if you’ve been dismissed from your school, well, don’t hold your breath until you’re accepted at another one.

Even if an applicant meets all requirements, acceptance with advanced standing is always contingent upon the number of spaces available, if any. Beth Bailey, director of admissions for the University of Virginia School of Medicine (UVa), says that while UVa does consider third-year transfers for admission, no spaces have been available since 1995. Prior to that, Bailey says, no more than two third-year slots have ever been available in any given year. And Patricia Fero, an admissions officer at the University of Washington School of Medicine, says Washington has accepted a total of two transfer students in the past 10 years.

Is it any surprise, then, that with these kinds of odds, transfer in medical school is not the path to an upgraded academic pedigree that an undergraduate transfer can be?

Rob Chisholm, a third-year student at the University of Texas Health Science Center at San Antonio (UT–San Antonio) who transferred there from Philadelphia’s MCP Hahnemann University puts it succinctly. “There’s the whole line of thought that if you transfer laterally, it’s possible,” he says. “But if you try to transfer up—if I would have tried to go to a Yale or a Harvard, that would probably have been impossible.”

Dr. Leighton Hill, senior associate dean for admissions at Baylor College of Medicine in Houston, which accepted approximately 15 percent of total applicants in 1999, confirms Chisholm’s suspicion. “One of the things we look at is whether [a transfer applicant] would have been admitted to our first-year class,” he says. And Temple’s Uknis says her school “almost never” considers a transfer applicant who wouldn’t have gotten in a year or two earlier.

While few schools appear to be as open in their efforts to discourage students from leaving as Ambrose’s, a random, unscientific poll of deans at medical colleges and universities around the country uncovers some who are eager to aid the process.

“We certainly don’t encourage transfers,” confirms Dr. Dennis Nadler, associate dean for undergraduate medical education at the State University of New York (SUNY) at Buffalo School of Medicine and Biomedical Sciences. “We believe that if someone has signed up to be educated with us, they’ve made a commitment, just as we’ve made a commitment to them.” But Nadler is no hard-liner, preferring to handle transfer requests on a case-by-case basis.

“We try to be human about it,” Nadler says. “We don’t write letters of recommendation for transfer. We don’t ever recommend that someone transfer.” But SUNY–Buffalo will verify a student’s good standing and forward a transcript without levying an additional charge, Nadler says. Like many other deans, he will usually accept marriage as a compelling reason to transfer, but not necessarily engagement.

“If you are in the Navy, there are times when for six to nine months out of the year, you’re on a ship someplace,” Nadler explains. “To us, just the idea of ‘I’m lonely’ does not constitute a compelling reason to transfer. [But] we won’t obstruct it.”

Dr. Peter J. Katsufrakis, associate dean for student affairs at the University of Southern California School of Medicine (USC), takes a more sympathetic view. Though he says he receives requests from students for his help leaving USC for another school less than once a year, he is always receptive.

“My practice has been to support the student,” Katsufrakis says. “I realize that when they come to me, they are usually in a difficult situation already.” He believes that administrators who take a purely dollars-and-cents view when a student asks for help applying to another school show a lack of sympathy unbecoming a good physician. “The loss of income to our school cannot compare with the pain of being separated from a spouse or missing the last six months of a parent’s life,” he says.

But he cautions that transferring for reasons less serious than these probably isn’t worth the cost, both monetary and emotional, to the student. “You’re giving up your social support network and immersing yourself in a new environment,” he says. “You don’t know anyone.” Along with the burdensome rotations every third-year student endures—and the difficulty of completing one’s academic program out of sequence because of the delay awaiting Step 1 scores, as Ambrose did—this added sense of isolation will be a cross too heavy for many students to bear, Katsufrakis warns.

Despite these difficulties, many students appear ready to take extravagant measures to transfer to be near a loved one. As the requirement for students to present a compelling reason for their transfer request has become commonplace, so has the potential for students to lie about it, says Kara Johnson, who works in the admissions office at USC. “I’m not saying it does happen, but I’m saying it can happen,” Johnson says. But she says USC’s admissions committee relies on the honor system when students present their reasons for transfer. “We expect them to tell us the truth,” Johnson says.

Johnson isn’t the only one wondering how many applicants are truthful about their motives. One third-year medical student among the 59 who tried unsuccessfully to transfer to USC this year had high hopes that she might finally be able to move in with her husband, a lawyer in Los Angeles. She was ranked “in the middle” of her class and scored “above average” on Step 1 of the USMLE. She is doubtful that all 11 of the transfer applicants USC accepted had more compelling reasons for seeking transfer than she did.

“It seemed fishy to me,” the third-year says. “I don’t know what their applicant pool was, but I can’t imagine that all of them had parents dying in Los Angeles.”

USC’s Katsufrakis responds that while compelling circumstances are the primary consideration when evaluating a transfer application, the school’s usual academic standards remain in place.

Nadler, meanwhile, recalls a case wherein a couple moved up their wedding date by more than a year after another New York medical school refused the groom-to-be’s request for transfer. The couple returned to the school’s admissions committee with their new marriage license in hand and asked them to reconsider. When an admissions officer called Nadler to discuss the case, Nadler gave his reluctant blessing, and the student was admitted.

Chisholm says that both marriage and a friendly relationship with the deans of both colleges were integral to his successful effort to enroll at UT–San Antonio in his second year.

“I had met all of the deans there from working [as the American Medical Student Association’s (AMSA) legislative affairs director for the 1997–98 academic year],” Chisholm says. “So I had face-to-face knowledge of all of the folks that I wanted to talk to about transferring, and they knew me as a person, so I think that helped. They also knew my wife. So they knew we weren’t trying to buck the system, or something weird like that. They knew that we were serious, and that I wanted to go to school down there.”

The fact that MCP Hahnemann declared bankruptcy during the year Chisholm left to work at AMSA’s national office in Reston, Virginia, made the decision to transfer even easier once he met his fiancée, then a third-year medical student at UT–San Antonio also on leave to work for AMSA. Because Chisholm knew well in advance that he intended to transfer—and because he had the uncommon luxury of a year off while he laid the groundwork for his transfer—he was able to conduct a subtle but persistent lobbying campaign on his own behalf, speaking frequently with the deans at both MCP Hahnemann and UT–San Antonio.

“It’s crucial to have a very strong relationship not [just] with the dean, but with the dean’s assistant,” Chisholm says, “because they’re always in the know.”

By pure chance, Chisholm also benefited from what he calls a “simpatico curriculum” among the two schools: Both MCP Hahnemann and UT–San Antonio teach immunology, traditionally a second-year course, in the first year. Even then, Chisholm had to wait for a second-year student at UT–San Antonio to drop out before he could enroll. He gambled and moved to Texas with his new wife, learning of his acceptance only “a week or two” before classes began.

Unlike Ambrose, Chisholm encountered no administrative resistance to his request. Indeed, Chisholm has nothing but praise for the way MCP Hahnemann officials dealt with him throughout the transfer process. He ascribes this fact to polite determination.

“You don’t go to them with questions. You say, ‘I need your help, and you need to help me,’” Chisholm says. “If you go there with an agenda and a plan, and you are very polite and serious about it, they will respond.”
Christopher Klimek is an associate editor of The New Physician.