The Top Ten Surprises About Med School, as Told By a Doctor

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Editor's Note:

Richard Beddingfield, MD is a practicing cardiothoracic anesthesiologist at a busy community hospital in downtown Madison, Wisconsin. He is the author of Med School Uncensored, an insider’s guide to surviving med school. Here, Richard shares the top ten surprising facts about attending med school.

The process of becoming a doctor is a long, arduous journey, with many surprises along the way. I officially started that process with my first day of medical school in 2006. Nearly a decade later in the summer of 2015, I became a board-certified cardiothoracic anesthesiologist and started my first job as a bona fide physician. Thinking back on those challenging and amazing years of my life, a few things stand out as especially surprising and unexpected. Here is my list of the top ten surprises about med school.

1. There’s always a “dumbest kid in class”—but he or she is still really smart.

As many American medical schools now employ a pass/fail grading scale for much of the curriculum, a popular saying I encountered when fellow students would stress about an upcoming exam was P=MD, meaning so long as you pass, you’ll still become a doctor. Obviously, it’s not quite that simple, as everyone still has to pass the medical licensing boards and do well enough in med school to get into their desired residency specialties and programs. But the fact remains that in each group of newly graduated doctors, there’s always a few that “barely made it.” Thankfully, my observation was that even these students were still really, really smart—and all went on to become very talented and compassionate physicians.

2. There’s never a shortage of people willing to lend you money once you’re accepted to medical school.

Many pre-meds worry about how they will pay for medical school if accepted. Indeed, this isn’t an unjustified concern, as the average four-year cost of an American medical school in 2016 (including books and expenses) was about $270,000—a bit more for private schools, and a bit less for public. But the real concern shouldn’t be how one will pay for med school. I assure you there are myriad public and private lenders who will gladly lend accepted med students more than enough money to earn a medical degree. These lenders know that after a decade of training, these borrowers will be among the most stable and secure sources of money—in the form of that lovely thing called compounded interest. The challenge for med students is to minimize the amount they borrow as much as possible throughout all of medical training.

3. The MCAT (Medical College Admissions Test) is only one of many important exams physicians take throughout their careers.

Though pre-meds often consider the MCAT the most important exam of their lives, the process of becoming and being a physician is filled with hundreds of exams, including medical licensing exams (“the boards”), specialty certification exams, and maintenance of certification exams that are taken throughout a physician’s career. Many of these are all-day affairs that take place in sterile cubicles at professional testing centers.

4. Choosing a specialty is a complicated, often competitive process—and many medical students are unable to pursue their desired specialties.

Many incoming medical students think choosing a specialty is as simple as telling a guidance counselor, “I’m going to be a neurosurgeon.” This is how most students declare their undergraduate majors, after all. Unfortunately, not all specialties are created equal, with more competitive specialties requiring higher board scores, better grades, and more extensive research and leadership experience. For better or worse, the rat race of maintaining a stellar GPA and “doing whatever it takes to get in” doesn’t stop upon acceptance to med school!

5. Caribbean medical schools offer a “second chance” for pre-meds not accepted to American M.D. or D.O. programs. However, gaining admission to a Caribbean med school is far from a guarantee that one will ever graduate with a medical degree.

Many college students with dreams of becoming a doctor fall short of the stellar GPAs and MCAT scores expected of applicants to American medical schools. A variety of for-profit med schools based in locales like Aruba, Dominican Republic, and Grenada—collectively referred to as “Caribbean medical schools”—offer acceptance to med school with far less rigid academic requirements. This is a great option for certain students who have overcome their academic challenges and are confident they can do extraordinarily well on their board exams. But a major drawback of these schools is that graduation rates are often as low as 50-60%. That means nearly half of accepted students at some Caribbean schools never graduate with a medical degree—and an even greater percentage never pass their boards, but they still come back to the United States with six-figure student loans and no obvious way to pay them back. Proceed with caution!

6. A lot of med students do end up sleeping with one another by the end of four years.

Medical dramas on TV have always glamorized the sex lives of med students, residents, and practicing physicians. In reality, I can’t say it was a common occurrence to see med students and nurses stumbling out of call rooms at 3:00 in the morning, their hair and clothes askew. Did such scandalous things happen? I’m sure of it. Were such trysts frequently interrupted by a beeping pager or overhead call for a medical emergency? Undoubtedly. But scandals aside, far more common were (usually) single med students entering into relationships—however fleeting—with each other. This shouldn’t be surprising, since the rigors of med school and residency leave little time for a social life outside of the all-consuming world of the hospital. But by the end of four years, parties could be a bit awkward once you realized that half the room had slept with the other half at some point during med school.

7. A surprising number of patients “accidentally” fall on elongated objects after slipping on wet floors when getting out of the shower—naked, of course.

Coming off the topic of students’ sex lives, I’m reminded of the dozen or so patients I encountered throughout med school and residency who presented to emergency rooms and urgent care centers with the cliché story of “slipping” on the bathroom floor while naked and landing so precisely as to have all sorts of random objects insert themselves into various orifices. At risk of offending readers, I’ll omit the details. Nonetheless, the frequency with which this classic story occurs in real life was surprising to me—as was the degree to which the patients telling the story thought everyone actually believed them.

8. Most American medical students come from families with above-average incomes.

Coming into med school, I assumed most accepted students likely came from good schools and probably had a lot of parental and community support in order to get as far as they had in life. The degree—and magnitude—to which this is true surprised me, though. According to the most recent statistics collected by the organization that regulates American medical schools, almost 60% of incoming students in 2005 came from families whose incomes were in the top quintile of American households. By contrast, only about 10% of new students came from families whose incomes were in the bottom 40%. Access to medical school for young adults of below-average means is improving—but slowly.

9. The average age of matriculation for American med students is about 24 years, but nearly every medical school class has a few brave souls that depart from this norm.

I was 26 years old on my first day of med school, which was a tad later than average. But I was pleasantly surprised that not only was I not a tremendous outlier, but there were students in their 40s, with several children at home, with prior careers that were impressive in their own rights, and with an array of life experiences that were sometimes far from expected—such as street performing, construction work, and practicing law. Don’t be discouraged if you dream of being a doctor but don’t “fit the mold” of the average pre-med.

10. Dealing with death never gets easy—and many med students and patients are not well prepared for it.

Going through medical school, residency, and ultimately medical practice gradually makes physicians more comfortable with the idea of developing close relationships with patients and their families, only to have those same patients grow ill and sometimes die while still in one’s care. But this is frequently very upsetting for young physicians, who have sometimes experienced few examples of death among close friends or family. I was even more surprised in my training by how difficult the concept of mortality sometimes was even for elderly patients—and more commonly the families of such patients. Our culture tends to look a blind eye to death and try to brush it under the rug. Going through medical school teaches future physicians that death is just as much a natural part of life as birth, despite how much we tend to resist it.