4//2001 to Health Prof
From both sides of the fence, med school and community
A PA interested in medical school will need to complete the four years of
medical school. When I was at East TN State I asked some medical students
that were physician assistants whether the time could be shortened. They
said that it could not, from the stand point of intensity and the
socialization role.
Those who know what they want to do, should go ahead first time.
Those who find out later what they want to be, may face a tougher road
because of family and other commitments, but there is also great reward.
I know PAs who went to med school who graduated, returned to their town and
are still in their town where they were a PA.
I know med techs who went to med school who advised national panels on
office laboratory regulations
I know nurses who have gone to medical school and have a much broader
vision of health care in many areas.
I have an M-1 student in my small group who is a pharmacist and he is a
valued member of the group. I wish we had more pharmacy types in medical
school because they are all dedicated to serving people. In the more
isolated locations a combined pharmacist/physician would be ideal (no such
thing to my knowledge).
Frankly we need much more atypical medical students, ones who do care more
about people and communication and a bit less about diseases and
technology. Family medicine and primary care depend on these students. The
nation is short on geriatrics and mental health for many of the same
reasons, Now that it is clear that research dollars are going up (16
billion) and primary care dollars are going down (200 million) there will
be even more pressures to get more MD/PhD students which means fewer
service types. But alas, we have had this discussion before.
rbowman@unmc.edu
Dear Advisors,
In the last week there have been some interesting comments generated by
Jodi Lin Black's question about a student enhancing herself for medical
school admission by first becoming a physician assistant. The general
feeling seemed to be that allied health majors should not be used as
stepping stones to medical school but rather be pursued because of inherent
interest in the practice of that profession.
I have had contact with a few allied health programs that actively recruit
students on our campus (mainly respiratory care and clinical laboratory
sciences (a.k.a medical technology)). These programs market themselves to
students who are interested in medicine by advertising medical technology
(CLS) and respiratory care as good majors for students who want to go to
medical school. They feel they are benefitting students, especially weaker
ones, by providing them with an insurance policy for a career if they are
not accepted to medical school. They also promote the skills taught in
their programs as very useful once a student is in medical school.
The official line of prehealth advising at my institution is that
professional degrees (PA, PT, OT, nursing, pharmacy, cytotechnology,
medical technology, clinical laboratory sciences, respiratory care---and
outside of the health professions, degrees in accounting and business) are
excellent choices if the student wants to go into that particular
profession. These programs are not stepping stones to be used as a means to
get into medical school. They are professions in their own right, valuable
ones. However, if a student gets relevant experience once they have
received their degree in one of these areas, and then decides that he or
she wants to go into medicine this is fine and the applicant can often wind
up being both interesting and competitive. Usually, this will also mean
finishing up the premedical prerequisites after the student has graduated.
The programs in question do not like to hear this advice at all!
Occasionally it gets back to them when students who have come in for
prehealth advising later go to speak to them about their programs. courses,
It seems that the students who are recruited most successfully by the
programs are in many instances people who do not have a family background
in the higher educational system to draw upon--recent immigrants and
disadvantaged students. With a realistic plan, I think that these students
would be able to reach their goal. I fear that they are being side-tracked.
This is one of the thorniest problems I have encountered as an advisor. I
have been criticized directly, and to the administration, for not promoting
the usefulness of their programs for premed students. I have an email on
my desk from one of these programs asking that I "encourage premed
students that are interested in one of the undergraduate health professions
to CONTINUE to pursue it as a major. It appears that we should not be
concentrating on what a student majors in, but rather their GPA,
prerequisite coursework, MCAT scores, etc." Completing the prerequisites
within these majors also usually requires at least one summer course,
either Organic or Physics. I won't even mention that these courses of
study, which take two years, often preclude the possibility of a student's
taking the kind of courses they need to improve their verbal reasoning
skills--often a crucial task for non-native speakers of English. I would
appreciate some feedback from fellow advisors about whether you get put in
this position and how you handle it.
I was very interested in Harry Pomeranz's comment that "how students make
their decisions in career choices, as well as in other areas, is a critical
issue in our evaluation." I would especially value opinions from medical
school admission people about how valid the perception is that these are
"good" majors for future physicians. Would you recommend them for freshman
who want to be physicians? Are there extenuating factors that make them
more viable? Does working in the field for which they were trained first
and then seeking medical school admission make for a stronger application?
I apologize for the length of this posting but am trying to give you enough
background to understand my dilemma. It would help to know whether my
perceptions are based on reality or health profession advising myths. I
would hope that we don't suffer from the same dynamics that generate premed
student misinformation.
Thanks in advance for helping with my reality check,
Susan Cooperman
Data published by AAMC in the past has indicated that nurses, medical
technologists and other allied health professionals have tended to score poorly
on the MCAT and/or have low acceptance rates to medical school. Discussions of
the former trend have suggested that poor MCAT performance may be related to the
"applied" nature of instruction in these curricula as opposed to broader
exposure given to science majors. I don't know whether the latter is related to
resistance by medical admissions committees to the stepping-stone concept.
Admittedly the sample size is relatively small.
Joseph H. Lechner, Ph.D.
Professor of Chemistry
Mount Vernon Nazarene College
800 Martinsburg Road
Mount Vernon, OH 43050-9500
[740] 397-9000 extension 3211
The current volume of the MSAR still shows a lower than average acceptance
rate for nurses and medical technologists suggesting that nowadays the
problem is not bias against women. My interpretation of this statistic - as
with the statistic showing that premed majors have a lower acceptance rate
vs most other majors (for 2000-2001 class: premeds 37% accepted, philosophy
60% accepted, for example) is that students from these background who did
not perform well academically are more likely to apply anyway than, for
example, a philosophy major with mediocre credentials. A nurse or med tech
who had mediocre academic performance may feel that her/his experience will
make up for the academic weakness.
As for recruiting of premeds into nursing or other allied health majors, I
have had to battle this one too. Typically, the allied health department
was having trouble recruiting sufficient students into their program and
decided that tapping into the large number of premed applicants was a way
to boost their enrollment. When I objected I was asked if Med Tech was not
a good way to prepare for med school. My response was to the point:
If a student truely wants to become a med tech, then med tech is an
excellent curriculum that can - and frequently has - produced top-notch
medical school applicants. If the student has no interest in actually being
a med tech, I would not suggest this as a viable alternative any more than
I would tell a student to choose philosophy or biomedical engineering or
any other major in which he/she was not truely interested. My advice to
students has always been to choose a major in which they are interested and
which would give them a career they would want should medicine not work out
for them.
Ron Gratz
At 10:09 AM 2/12/02 -0800, you wrote:
>On the other hand, each of the nurses who has come to my school over the
>past 20 years (prob 10 of them) to complete a bachelor's degree--in
>majors like Biology, has successfully entered medical school or
>osteopathic medical school around the country and locally. In my
>experience, because of their maturity and focus they have usually
>compared well with our best postbaccalaureate students. All of them
>have already been successful in other fields.
>Cecilia Fox, Occidental College, LA, CA
Paul Matthews writes:
<<Surely a group of persons as well educated and experienced as the members of
this group have a good "feel" for the part of the "pre-med" population you
advise who will not get into med school. Why not do as your colleagues in the
Nursing and Allied Health departments request. Send those students to talk to
the Nursing and Allied Health folks.>>
Yes; that is indeed what we do. Some students who have entered college declaring
themselves "pre-medical" end up changing their interest to PT, OT, PA, or MT.
The change is rarely prompted by lack of academic ability. Other considerations
have included years of future education, desire for more leisure time, marriage
plans and the desire to raise a family.
In my 22 years here I can only recall one student who entered an allied health
program intending to use that as a stepping stone to an MD program. That
individual flunked out of the allied health program. So, I do not see any trend
of allied health professionals stepping up to medicine.
Our "pre-med" students who switch to other health professions, DON'T choose
baccalaureate nursing programs. The BSN curriculum is too different than the
others, and there are too many "wrong" courses to make up. The few ex-pre-meds
who wanted to become nurses have completed biology degrees and then gone on to
entry-level masters, N.D., or nurse-practitioner programs.
Joseph H. Lechner, Ph.D.
Professor of Chemistry
Mount Vernon Nazarene College
800 Martinsburg Road
Mount Vernon, OH 43050-9500
[740] 397-9000 extension 3211
Recent postings have noted some degree of certainty in the screening of
candidates. This may not be as evident to those newer in the game as
advisors. Experience certainly contributes greatly. Perhaps more important
is the great variety of the contributors and members of the list serve.
Colleges vary greatly in their student populations. In some virtually all
could qualify for medical school. In others relatively few. Some schools
have a variety of medical careers, others have just a few. All of us have a
variety of amounts of time to spend on advising, often over and above other
duties.
Also remember that we are limited in the amount of time that we have
contact with students. We rarely get the kind of long term feedback over a
number of years that would allow us to make judgments regarding college
level efforts. One example comes to mind immediately with others similar to
this in my other locations. One student was in college for awhile, then a
fireman, and a paramedic. His admission to the U of Arizona was blocked
because he had borderline scores and MCAT. The interview did not go well
and he was told, "Why don't you continue to serve as a paramedic where you
are greatly needed?" His passion was to be a physician and he went overseas
for medical school with his family and kids and then returned. He was the
best resident that we have had in maturity, personal skills, leadership
(chief of all the chief residents), productivity, and just about every
measure. His whole career was about overcoming obstacles. He was told that
you could not return to certain parts of Arizona due to the health care
climate, now he runs a large practice with other doctors.
My view is limited because I know mostly rural doctors but this is a brief
list of the kind of careers some of them had - PA (several), nursing (3),
med tech (2), farmer (2). All had exposures to medicine that encouraged
them to take a different and difficult pathway. My bias is that they have
made greater contributions to communities, medical associations, health
policy, and other areas. Don't know this for sure, but it makes sense.
Keep your eyes open for these folks who have potential, but not the
numbers. They need you, perhaps more than the other students. Medical
school admissions committees may not be willing to listen, but perhaps they
will change their tune. Other medical schools may listen. Hopefully you
will have the chance to talk to them.
Just don't want us to forget important postings in the past regarding the
important role of advisors in encouraging certain types to apply to medical
school and making perhaps less efforts with those that are less likely, due
to various criteria such as academics, personal, etc. This is the nature of
being human. As teachers and advisors, it is important that we are aware of
this and take steps to compensate.
I will continue to encourage you to be encouraging and objective with
students who may be at risk of academic failure, but have strong
interpersonal and service qualities.
Past postings have noted the difficulties that advisors face when assessing
certain types of students, the difficulty with giving true acceptance
rates, etc.
I do trust advisors to make such evaluations. Perhaps no one else has
access to the kind of information needed and also is in a position to make
an objective evaluation. I really do see an important role for advisors
working more closely with admission committees.
I really do think that medicine is facing more desperate times than it
imagines. The key to better doctors is better admissions, first and
foremost. Next to this is continual re-examination of the process of
medical education.
Robert Bowman
Rbowman@unmc.edu
Thanks for your post. It helped to clarify matters for me.
PJM
Education - the entire pipeline
Nurse Practitioners and Physician Assistants