Rethinking How to Get Into Med School
Check out this article explaining the new thinking on getting into medical school. The MCAT is changing, medical school itself is changing and now who they are picking for medical school is changing. At Mount Sinai, a “growing percentage came through a humanities-oriented program” where “they majored in things like English or history or medieval studies. And though they got good grades, too, they didn’t take the MCAT, because Mount Sinai guaranteed them admission after their sophomore year of college.”
This is interesting. No MCAT. No hardcore science majors. What is going on here? I am all for doctors having better personalities. I guess the feeling is that the pool we draw from is the reason for stiff, uncaring, robotic physicians. But isn’t that an assumption? How do we know it’s NOT the system itself that beats doctors up, which causes them to be burned out and lifeless?
I am always suspicious of major changes in the pipeline of becoming a doctor. There is a great trick I have seen in the past that is used over and over again. It’s one where the powers that be create new solutions to issues that didn’t exist in order to cover up real problems. I get the that sense here. Why? Well, read this paragraph from the piece:
Studies have shown that the students in Mt. Sinai’s Humanities in Medicine program are just as successful in medical school as the students who take more science classes in college. And they are slightly more likely to choose primary care or psychiatry as a specialty — both areas of high need.
Do you see it? Somehow they think that taking non science majors will create more family docs and psychiatrists! So of instead of fixing the pay for these careers (the ONLY answer,) they are trying to go back in time and see if picking the right students will help. It won’t. Instead those students who majored in hotel management, anthropology and literature will still pick the highest paying specialties and eventually be as grumpy, bitter and as cynical as the doctors of today. And you still won’t have enough family doctors or psychiatrists. You can count on it.
As a former physician with an initial BA in English (3.2 GPA in my major 3.9 GPA in science) I am pretty proud of my 10, 10, 11 on the MCAT. Yes I went into Primary Care (Pediatrics) but left after 12 years for fellowship training. Money wasn’t the primary driving factor though, it was time. I say bring on the humanity majors but for goodness sake, don’t lower the standards.
As always spot on, Dr. Doug. “Guaranteed admission”? No MCAT?? However, I’m still not sure higher pay would be the salve for primary care (glorified first aid prior to seeing specialists, or “real doctors”) or psychiatry (the Rx-writing son of psychology, pretty much a b.s. science if there ever was one) because you still have to deal with demanding and often crazy patients. I was making a crapload of money working for “the Man” when I threw in the towel last year, and I still don’t miss it. We still have to emphasize the sciences in students’ training…without a stinky organic chemistry lab how are you ever going to get med students to do gynecology??
Bureaucracies love the principle of appearing to change while leaving the core axioms untouched. The general myth of the education system is the pretense that there are a plethora of brilliant and equally qualified students, far more than any one school can select. Some special ‘jazz’ is needed to pick out the cream of the cream – an Olympic beach volleyball champion, a tenor at the Met, some gadget or trick that will play well at the Dean’s cocktail party.
But, in an evolutionary metaphor, you get what you select for; and having a plethora of species competing for one niche, you wind up with powerful selection for homogeneity. They all look the same because they are competing to all look the same, and frequently by dissimulation. The skills selected for are ruthlessness and acting ability. As long as the axioms remain, they act as evolutionary pressures; and they will select for the same product. This is hardly new or different. Society’s plethora of labels exist to make the same spirits look different in the flesh; skin color is one of them. Gender, location, sexual preference – those are all indicia of individuality, treasured by the educational bureaucrats for the entirely wrong reasons.
Are there reasonable skills to select for? I would want to see first, Hemingway’s criterion for the writer – “Having a good bulls*it detector.” The next metaphors would come from the military scholars – to find and fight the enemy, one of the simplest concepts, but rarely used effectively in war. That is all there is to medicine – to marshal the utmost force in a reasoned manner to terminate a threat. “All the rest is only an explanation of that,” to quote Hillel on another matter.
But the problem is always – “It’s hard to fight an enemy who has outposts in your head.” To assimilate into a largely intimidating bureaucratic system that fears competence, one must learn how to be servile and nonthreatening, at least on the outside. Do not stand out. Do not align your skills and drive to reform the axioms of the systems. “Making medical school more humane,” to the owners of the medical schools, means bringing in people with training in ‘the humanities,’ which in our country is seen as a filigree, an oddity, an eccentricity; intimidating such folks with the club of science and maths, to get them used to fear and servility; and then toss them onto the conveyor belt that dumps end-product physicians where they are to be dumped.
The danger of taking in people truly skilled in the humanities, is that they might have bullshit protectors already in place; there is no more certain way to be yanked off the conveyor belt than too much affection for the truth. Can they be cowed and driven easier than the lot who comes in the front door now? Perhaps, but what a danger!
The system is actually quite feeble and ineffective – don’t mention that! Take it seriously, pretend to take it seriously, and you can rise to the cutting edge of the dilettante ranks, the self-congratulatory and bombastic ranks of a Medical Educator – and shepherd young and impressionable minds down your favored pathway. As a very angry young man said years ago, “Woe to you, teachers…., you hypocrites! You travel over land and sea to win a single convert, and when you have succeeded, you make them twice as much a child of hell as you are.” That should be carved in the entrance-way of every Dean’s office in the land, but it’s not – and woe to the physician in training who should get a glimpse beyond a blinders of that woeful fact. What is in human endeavors, exists because someone has chosen to be so; and it persists because someone has wished it to persist. If that is so, it is has harsh implications for what we do and what we say in many areas – Medical Education being one of them.