Getting Past Rejection
Paul Jung, M.D.
The next step in the process

When the results come in on medical school applications, what should you do if you don't make the cut? Should you apply again? Well, that depends. There are considerable costs and time involved with applying to medical school, especially if you decide to take more undergraduate courses or enroll in a Medical College Admission Test (MCAT) review class to retake the exam.

Here are a few considerations that may help you make this difficult decision:

• How can your application improve? Many premeds make the terrible mistake of simply applying a second time without significantly improving their applications. There must be a substantial improvement in your new application for the admissions committees to take notice, such as a significant grade-point average or MCAT score increase, new publications or awards, or a unique job or extracurricular activity. Don't count on every other applicant becoming less competitive next year. You must take it upon yourself to improve your application.
  
  
• Did you follow all the best advice and not make any mistakes? Often, the process of applying is just as important as the content of your application. If you feel you made several mistakes-such as submitting application forms late in the cycle, having only three recommendation letters available for your application, ignoring osteopathic schools or only applying to a few competitive schools-be sure to rectify these during the next application cycle. There's no point in making the same mistakes twice.
  
  
• Realistically, what are your chances? Some students have simple faults in their applications that can be easily remedied the next year. For them, reapplying is not a difficult prospect. However, other premeds with horrendous grades, little social ability and no compassion for humanity still insist on applying to medical school against the advice of others. It is important to sit yourself down, look in the mirror and ask yourself if you have a realistic chance of being admitted to medical school. If the prospects look grim, even with significant effort, move on to something else.

But what else is there? Let's say you've tried several times to get into medical school-you've taken more courses, sat through the MCAT as many times as you could stand, but still didn't get accepted-and now you're fed up with the entire process. You must ask yourself, did you apply to medical school because you wanted to be called "doctor," or did you apply because you really wanted to help people? If it's the former, there's not much you can do now. If it's the latter, there's a world of opportunity in the "helping people" business. Here are some options for those of you unable to obtain admission to a U.S. medical school:

• Try another health-care career. If you're really interested in helping people, then surely you wouldn't mind doing it in a career that has all the same exciting patient-care possibilities as being a physician, albeit with perhaps less prestige. If you're still willing to get your hands dirty taking care of people, there are many things you can do. The national nursing shortage has opened opportunities throughout that field. You might also want to consider becoming a physician assistant, clinical social worker, pharmacist or psychologist. These careers are by no means "easier" than being a physician-some of them are just as, if not more, rigorous. Give them all a thought, for these members of the health-care team are just as crucial to patient care as are physicians.
  
  
• Consider offshore medical schools. OK, maybe the thought of working as anything other than a physician is too unbearable for your ego. So here's another option for you: offshore medical education-a medical school located outside the United States or Canada. You may have heard of some of these institutions based in the Caribbean, Mexico and even Poland. Chances are, more than a few physicians in your community have spent some time at one of them.

Offshore medical schools are by no means equivalent to those in the U.S. They can be far more expensive, yet none are accredited by the same governing bodies as are U.S. schools; one major reason is because none of them have adequate teaching hospitals for students to complete their clinical clerkships.

So, many offshore medical students spend their basic science years on a tropical island and their clinical years at hospitals throughout the United States and Europe; many perform their clinical training alongside U.S. medical students and residents. And afterward, some graduates successfully obtain a residency in an accredited U.S. hospital.

One way to think about the prospects of an offshore education is this: If you go to an offshore school and do well in the first two years, you may have a small chance of transferring to a U.S. medical school. If you can't transfer but continue to perform well during your clinical years at an accredited U.S. hospital, you have a chance to obtain a U.S. residency. But despite that, there are still significant obstacles for offshore graduates to obtain clinical clerkships and residencies in the United States. Nothing is guaranteed at these schools.

For example, even if you complete all your clinical rotations at U.S. hospitals, you're still not home free-whether you're a U.S. citizen or not, before you can apply to a U.S. residency, you must receive certification from the Educational Commission for Foreign Medical Graduates (ECFMG). This certification requires passing an English test (even if it's your native tongue), as well as an extensive clinical skills exam. This test is offered only in Philadelphia and costs $1,200, but testing sites are expected to expand by 2004.

Graduates of U.S. residencies who have passed all three parts of the medical boards are eligible for state medical licenses, regardless of what medical school they attended, even if it was an offshore institution. Granted, if you're an international medical graduate, your chances of becoming a dean at a prestigious teaching hospital are very, very slim. But if you simply want to practice medicine, an offshore medical education may be your ticket to a long, white coat.

As with any medical school application, be sure to research the institution before you apply. This is especially true for offshore schools. Remember, they're very expensive, not including the costs of living in a tropical country or abroad. And think twice. You should never enroll in an offshore school without consulting at least one U.S. citizen who is a student at or a graduate of that school and without seriously investigating all the regulations and requirements of graduates of non-U.S. medical schools who wish to practice in the United States.

As a rule, I never have nor will recommend an offshore medical school as the first choice for any U.S. citizen, simply because the barriers to returning to the United States to practice are often too high. Because of the many hurdles their graduates face, offshore schools should be viewed as a second option only after unsuccessful applications to U.S. allopathic and osteopathic medical schools. This is not meant as an indictment against the quality of education at these schools or the quality of the physicians who graduate from them, but rather a practical consideration given the current political and administrative climate surrounding medical licensure and practice in the United States.

For more information on the certification process for graduates of offshore schools, visit the ECFMG Web site at www.ecfmg.org.

So whether your destiny lies with another round with the American Medical College Application Service, a pair of nursing shoes, or medical textbooks on a tropical island, I applaud your determined efforts to help those around you live healthier lives. Good luck!

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