More than 15 percent of last year’s new crop of first-year medical students completed a post-baccalaureate program. These programs exist in two flavors: one type helps students who want to improve their undergraduate academic record, and the other helps those who want to redirect their careers toward medicine, like me. Both are growing rapidly in number.

With so many future doctors launching their medical careers through a post-bacc, I was surprised by how hard it was to find student opinions on the realities of life in a post-bacc. Luckily, a few friends who had blazed the path before me were eager to advise. As those friends helped me, I hope this piece can help anyone else considering a future in medicine.

What do I mean by a “DIY post-bacc?” There are many formal post-bacc programs that offer excellent advising and academic support. Some of these programs even offer “linkages,” guarantees of medical school admission upon successful completion of the program. I had personal and financial reasons to take undergraduate science courses at my public university, Indiana University, and live at home. In what I call a DIY post-bacc, I designed my own 18-month schedule and built in time to do extra-curricular work.

For me, the most significant benefit of a post-bacc is the singular focus I could maintain on my academic studies and confirming my interest in medicine. My pre-med friends in college had to balance science classes with curricular requirements, extracurricular activities and social life, not to mention internal debates they faced about whether medicine was actually the future they wanted. Knowing I wanted to be a doctor, I focused solely on two to three science classes at one time. Anytime I studied, I studied with the MCAT exam in mind, knowing I’d be taking the test in just one year’s time.

The DIY post-bacc curriculum allowed me to strike my own balance between academics, shadowing and volunteering experiences. Friends of mine balanced research, too. I shadowed physicians of every kind — from primary care to surgery — and saw patient care in action. Patients were often discharged from the hospital to nursing homes, and I began volunteering with nursing home residents, developing relationships that transformed into friendships. I met my “first patient” through a cadaver prosection program, handled surgical equipment and cried with families of cadaver donors over their loss. Although most undergraduate pre-medical students take on similar activities, post-bacc students often feel their smaller class load and older age give them the time and maturity to empathize with patients and their families. This recognition that time and empathy are the bedrock of the patient-physician relationship is a lesson I seriously appreciate as I head into medical school.

At the same time, there were difficulties I had not predicted. I knew a heavy science course load would be challenging, especially since I had not taken classes in over two years. Surprisingly, though, the types of personal obstacles all post-bacc students face at one time or another strained me just as much as my science curriculum.

The most difficult aspect of changing careers and pursuing a post-bacc is the sudden loss of certainty. Lucky to have a great job in health care policy research, I had relative freedom to choose where I’d call home for work, graduate school and post-graduate work. On the path to patient care, I suddenly do not know where I’ll be attending medical school. Some schools have less than two percent admit rates, so choice of location is suddenly out of my hands. I’m in my mid-twenties now and could be finishing residency in ten years in a different city. I hope to be married and have kids at some point during this process, but I don’t know how feasible it is. In medical school and residency, patient care will take precedence over relationships and life, requiring a selflessness I had not considered before. My shift to medicine required me to re-think how I would prioritize things I once held close to me. Gaining comfort with these new uncertainties is difficult.

A second challenging aspect of pursuing a post-bacc is the immediate loss of independence. Before my post-bacc, I spent my time exploring Washington, D.C., visiting its museums and immersing myself in a growing community of friends. I grew accustomed to spontaneous activities with my friends, but at home, I lived at the library. I took on more personal stress than I had at work, knowing my class performance would be the difference between getting accepted to medical school and not gaining entrance. Medicine, with its major entrance exams at every stage, will maintain this pressure. I know medical school and residency will require further sacrifices of independence. It took me time to gain comfort with the fact that the independence I had cherished would not be mine anymore. In fact, as I shadowed, I learned that I gave up this independence for the privilege of prioritizing patients’ care above my own life. This is a deep responsibility, sacrifice and change from my prior life.

Next, completing a DIY post-bacc with undergraduate science students shrunk my community of friends in size and age. I liked the students I met at IU, but the age difference made it hard to form close friendships. Pursuing a post-bacc made it difficult to maintain my old friendships, too. I tried to visit and invite others to visit me, but I had to be prepared for my post-bacc, and my life in medicine, to create some distance in my old friendships. My post-bacc also put stress on my significant other. Distance in relationships is always difficult, so it was critical to communicate time strains and various activities, especially as my girlfriend is not in the medical field. That loss of certainty I mentioned earlier is something she feels deeply. We were lucky and navigated these challenges well. A post-bacc will likely stress all types of relationships, and it’s important to expect difficulties and discuss them beforehand.

All these challenges are not to be underestimated. When classes became stressful, it was important that I felt confident in my decision to pursue medicine. It is critical to think about the hardships you will face before entering a post-bacc. My excitement to care for patients one day was the only thing that kept me from running back to my prior life.

As I inch towards that goal of patient care, I feel extremely fortunate I had the resources to pursue a post-bacc, and I’m happy to have completed it at home and by my design. Students enter medicine from a variety of paths and ages. Each situation is unique. If you’re considering a post-baccalaureate, these are some of the realities I faced. I hope they are helpful to you.

Neil Kondamuri is an incoming medical student.

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