U.S. allopathic medical school applications have skyrocketed, with over 60,000 applications in 2021, a nearly 100 percent increase in applicants over the past decade. Despite modest increases in the number of medical schools and class sizes, the result has been an ever-declining acceptance rate, with less than 38 percent of applicants accepted in 2021. Hopeful pre-med students pour over the grievously limited data available through the AAMC (Association of American Medical Colleges), but the lack of transparency leads to dependence on advice from sites such as Reddit and Student Doctor Network, social media, and word-of-mouth to help guide their application process. Not to mention that an “apply everywhere” approach to increase the odds comes with a significant price tag—over $300 per school just to submit a complete application. In a time when mental health and burnout remediation are prioritized in the workplace, this system is a recipe for toxic stress and emotional exhaustion before these students even step foot on a medical campus.
The medical school admission process unfolds over a period of 12 to 15 months, but for hopefuls, preparation has been underway for years prior to the opening of the American Medical College Application Service (AMCAS) application. Semesters are filled with intense class schedules, campus life leadership, community volunteer opportunities, shadowing or working in a medical field, and test prep courses. GPA and MCAT scores, historically used as screening criteria, have become just another ingredient in the secret recipe of admissions. In efforts to develop a more holistic approach, objective criteria such as test scores and extracurriculars have been supplemented with stories of life challenges and psychosocial hurdles. With the recent Supreme Court ruling regarding affirmative action, many schools shifted to essay prompts about “your background” to help supply information on race—all in the name of holistic admissions. Unfortunately, this shift has further opacified the admission process and impacts applicants from all backgrounds. Now, personal statements that used to be about passion for helping others or an epiphany after caring for a sick relative are now relegated to rehashing a painful experience in life, like a race to the bottom of who had it the worst. It ties the individuality of the applicant to an external force beyond their control (personal illness or disability, racial discrimination, parental discord) instead of allowing them the freedom to express their unique personality and interests. In principle, striving for a “fairer” system that accounts for varying socioeconomic backgrounds and the accompanying challenges is creditable. However, a curtain has been drawn over the admissions process, with the behind-the-scenes visible only to those in closed-door committees with no reporting accountability. This opacity exacerbates anxiety and breeds resentment among all applicants. Meanwhile, relying on human subjectivity in the selection process introduces the potential for personal bias, error, and corruption. Like taking part in a game in which you don’t know the rules, the resulting mental burden is wildly destructive.
Over 70 percent of pre-med students report depression or anxiety, often attributed to the overwhelming hurdle of the medical school admission process, a number significantly higher than the self-reported rate of 20 percent for college students in general. Students newly exposed to campus alcohol and drug use are more susceptible to self-medicating with these behaviors to reduce stress and anxiety. This dependency on deleterious habits is only amplified in medical school, as evidenced by a study of first-year medical students revealing increased alcohol use and decreased exercise and socialization.
There are ways to maintain a holistic approach to medical school admissions while preserving a reasonably low-stress pathway for applicants. Medical schools can learn from adjacent strategies used on college campuses, such as publishing high-quality data, removing “optional” or “recommended” prompts, and providing more information on the current goals and priorities of the campus. A rejection assessment could quickly notate where an applicant was lacking to help guide strengthening their application for the future. An algorithm of essentials could be employed—i.e., GPA, MCAT, research experience, community service, leadership role, health care work experience. Allow students to check off those requirements and then be free to pursue other interests for the joy of the experience, not because of how it would look on their application. To demand a seemingly infinite level of mastery and innovation at such a young age in pursuit of an acceptance letter is bound to cause long-lasting mental health concerns and stifle the joy of learning and exploration. For the future of our health care system, where we will take part as patients, it is critical that we support the young people devoting their lives to the service of others. Now is the time to pull back the curtain and reveal the true inner workings of the admission process; only then can we move forward together.
Jessica Lee is an otolaryngologist.
