Why it's important to have a plan B.

[ThrowawayFormerPreMed]

Being five years in this journey post-undergrad, I wanted to shine some light to why it’s important to have a plan B.

My lifelong goal (if I became a physician) was to ensure I develop a practice that focused on tackling healthcare for the homeless and others who were on the streets. I grew up in a neighbourhood where poverty and homelessness were evident in the community – and the access for this population was simply not there.

When I was in undergrad, I told myself if I didn’t succeed the first time to get into medical school, I’ll just keep trying as much as I can. It’s all about resilience, right? WRONG. To be realistic, there’s less than 3% chance to receive an acceptance to a Canadian MD school from the total amount of applicants. It’s literally like playing the lottery with the hopes to win. I watched a small amount of my friends win the lottery on their first or second try, BUT many more people who fell through the cracks.

My GPA was >3.95 when I graduated from my program, but I had to write the MCAT 5x to try boosting my CARS (121 to 125…plateauing twice at 125) – CARS in general was difficult for me because I’m a former ESL learner so much of the vocabulary looked really foreign which likely affected my CARS understanding. I interviewed 3x at Ottawa being on the WL every year and never making it off (and this year looks the same as well).

Being in my fifth application cycle, I’m looking towards my future and financially, it isn’t feasible to keep throwing money into applications anymore… especially, when you have a family to feed and elderly parents to look after. At this point, it’s important to have a stable career to at least ensure that a foundation is set during your adulthood. Otherwise, if you continue to apply and not get in, you really are digging yourself a massive hole. 

To summarize, when applying to MD school it's important to set a reasonable limit of attempts and have a backup plan that you can start in parallel to your application, so you don’t end up like me trying to figure out an alternative stable career path five years down the road. 

[zxcccxz]

47 minutes ago, ThrowawayFormerPreMed said:

Being five years in this journey post-undergrad, I wanted to shine some light to why it’s important to have a plan B.

My lifelong goal (if I became a physician) was to ensure I develop a practice that focused on tackling healthcare for the homeless and others who were on the streets. I grew up in a neighbourhood where poverty and homelessness were evident in the community – and the access for this population was simply not there.

When I was in undergrad, I told myself if I didn’t succeed the first time to get into medical school, I’ll just keep trying as much as I can. It’s all about resilience, right? WRONG. To be realistic, there’s less than 3% chance to receive an acceptance to a Canadian MD school from the total amount of applicants. It’s literally like playing the lottery with the hopes to win. I watched a small amount of my friends win the lottery on their first or second try, BUT many more people who fell through the cracks.

My GPA was >3.95 when I graduated from my program, but I had to write the MCAT 5x to try boosting my CARS (121 to 125…plateauing twice at 125) – CARS in general was difficult for me because I’m a former ESL learner so much of the vocabulary looked really foreign which likely affected my CARS understanding. I interviewed 3x at Ottawa being on the WL every year and never making it off (and this year looks the same as well).

Being in my fifth application cycle, I’m looking towards my future and financially, it isn’t feasible to keep throwing money into applications anymore… especially, when you have a family to feed and elderly parents to look after. At this point, it’s important to have a stable career to at least ensure that a foundation is set during your adulthood. Otherwise, if you continue to apply and not get in, you really are digging yourself a massive hole. 

To summarize, when applying to MD school it's important to set a reasonable limit of attempts and have a backup plan that you can start in parallel to your application, so you don’t end up like me trying to figure out an alternative stable career path five years down the road. 

Absolutely agree that everyone should have a reasonable backup plan. Ultimately, if someone really wants to serve the community and make a difference in the field of health, it is possible to do so in of the numerous allied healthcare professions or even in other realms such as advocacy, law, public policy, etc. If someone has a "med school or bust" mentality, then there were probably other reasons for wanting to be a physician (i.e., wealth, prestige, etc.) - which are completely fine, but I get annoyed when people are disingenuous about it.

However, I don't like the metaphor that getting into medical school is like "playing the lottery". Pretending that its a purely luck-based process minimizes the accomplishments of those that do get in (i.e., they got in by chance) and discourages other people to apply. There is certainly some element of subjectivity but it is my experience that, over time, the strong candidates (especially those who are willing to learn from each application cycle) do get offered a place somewhere. Sorry to hear that you didn't have any luck after so many cycles. I would encourage you to keep applying, but I know that's easier said than done.

Also, the application process is not as bleak as you make it out to be. The acceptance rate among domestic Canadian applicants is ~15%, not 3%. 

[Persephone]

Yes having a Plan B is essential. There's no guarantee applications work out even after fine tuning for multiple cycles, and there is a degree of luck involved for sure. I agree with @zxcccxz, the acceptance rate is about 15% ish and your chances go up marginally the more schools you apply to. It's still a tough acceptance rate of course.

A good thing about having a Plan B is it takes some of the pressure off needing medicine to work out, and can let you live with a lot more sanity. Knowing you have an alternate plan you could be just as, or at least almost, as satisfied with is essential and how I approached applying (and I tend to think medicine is overrated in some ways as a career option, it's definitely a good career, it just isn't the only one that will lead to a satisfied, purposeful life, and there are plenty of dissatisfied people working in this field too, it has it's good and it's bad like any other job).

I was going to start on my Plan B if my first cycle didn't work out and keep applying as I pursued Plan B so that my life wasn't on hold. It's easy to fall into despair if you've banked everything on getting into medicine and it's not working out immediately. Don't do that to yourself, keep growing as a person and living your life, you only get one

[Tullius]

Is 15% a national figure?  I recall Ontario being around that, but outside Ontario I thought the percentages are somewhat more favourable.

[zoxy]

44 minutes ago, Tullius said:

Is 15% a national figure?  I recall Ontario being around that, but outside Ontario I thought the percentages are somewhat more favourable.

It's quite higher in other provinces. The AFMC docs has a breakdown for the success rate for each school by IP or OOP status. For English schools MUN, Dal, Manitoba and Sask are all over 25 percent odds of admission for IP applicants. OOP is of course a different story.

Since those provinces only have one school, it's easy to guess the IP admission odds. Quebec schools also have a ton of spots compared to Quebec's population but it's hard to make a direct comparison with CEGEP and everything.

AFMC doc (ignore 19/20 data as it's broken for every school):

https://www.afmc.ca/sites/default/files/pdf/2021_admission-requirements_EN.pdf

[zxcccxz]

1 hour ago, zoxy said:

It's quite higher in other provinces. The AFMC docs has a breakdown for the success rate for each school by IP or OOP status. For English schools MUN, Dal, Manitoba and Sask are all over 25 percent odds of admission for IP applicants. OOP is of course a different story.

Since those provinces only have one school, it's easy to guess the IP admission odds. Quebec schools also have a ton of spots compared to Quebec's population but it's hard to make a direct comparison with CEGEP and everything.

AFMC doc (ignore 19/20 data as it's broken for every school):

https://www.afmc.ca/sites/default/files/pdf/2021_admission-requirements_EN.pdf

That document is not very useful because it gives the impression of admission being significantly more difficult in provinces with multiple schools (i.e., Ontario) and easier in provinces with single schools. This is because the same applicant will apply to every single ontario school through OMSAS and because of the high population, it will seem like that there are way more applicants for each seat. 

A better document to look at is this one: https://www.afmc.ca/web/sites/default/files/pdf/CMES/CMES2019-Complete_EN.pdf

Table F-14 shows that the % of Canadian applicants who received at least one offer is ~20% and fairly similar among the largest provinces (~18% in Ontario, 20% in Quebec and BC, and 23% in Alberta). The acceptance rate is higher in manitoba, sask and the atlantic provinces (26%-30%).

[Tullius]

That's great, thanks for linking that.  Competitiveness of medical school admissions in Canada is so frequently exaggerated, on this forum and elsewhere.  I guess we can just use ~20% acceptance rate for the country from now on, with a higher rate for specific provinces.

[PeterL]

I often find the 15-20% acceptance misleading in one way for those who are not the majority (low SES and/or BIPOC). How many of that 20% are actually low SES and BIPOC? There's no extrapolation data on the acceptance rate, but I would think that majority (~80-85%) in that 15-20% acceptance would still come from a wealthy and majority background. 

Admission standards have not changed for a long time and it's long due for an overhaul. Since the AFMC call for action approximately a decade ago, very little has changed. Nearly all medical school classes still lack diversity in both socioeconomic status and BIPOC.

[Pakoon]

I think a blanket statement for acceptance percentages is very misleading, if you have a 4.0 and a 528, it's not 15% LOL, likewise if its a 2.3 and a 497 it's also not 15%. other factors obviously matter but I am just trying to say the strength of applications across the board vary, resulting in a varying degree of changes of getting in. There is an element of luck, but not as much as people make it out to be.

[capoo]

2 hours ago, PeterL said:

I often find the 15-20% acceptance misleading in one way for those who are not the majority (low SES and/or BIPOC). How many of that 20% are actually low SES and BIPOC? There's no extrapolation data on the acceptance rate, but I would think that majority (~80-85%) in that 15-20% acceptance would still from a wealthy and majority background. 

Admission standards have not changed for a long time and it's long due for an overhaul. Since the AFMC call for action approximately a decade ago, very little has changed. Nearly all medical school classes still lack diversity in both socioeconomic status and BIPOC.

I'm in Quebec where the med school admissions process is arguably the most accessible to BPOC communities (and things are improving for Indigenous communities, they have a separate stream) as well as people with low SES. The admissions process is completely anonymized (granted it's because of the CASPer this year because interviews got cancelled), but even then during the MMIs your scores are completely anonymized by third party evaluators before sending them to the schools you applied to. Also, you only need to finish a 2-year college degree at a college (most colleges here are public so you don't pay for anything apart something like 200$ of registration fees per semester), you don't even need to go to UG (and even if you do UG here is very cheap), there's no MCAT, nothing, application fees are not very expensive, and EC's don't even count (so whether you gained leadership from leading UG clubs and interest groups, or from trying to work 2 jobs and guide your alcoholic parents to live a better life, as long as you show those skills in the MMI you'd get exactly the same score). But even then, despite all those barriers, at least 80% of my med school class this year is still white, have doctor parents, are very well off financially, etc., aka still the classic med student. Some people just start farther ahead in life, have more privileges and thus more opportunities to succeed.

I think this is a huge systemic problem that couldn't (and shouldn't) be tackled by a band-aid fix by adding "racial points/SES points" or by creating a racial/SES/etc. quota to med school admissions alone. If anything, this would only create more resentment towards BIPOC/low SES communities, and it would even complicate things further if other marginalized groups (ex: the LGBTQ community, people with chronic diseases, neurodivergent people, etc.) also want to be represented, and honestly it'd be impossible to know when to stop if we went down that route imo. I think what Quebec did was a step in the right direction, remove as many barriers as possible in the med school admissions process, but ultimately I think that the society and the government also has a role in giving marginalized groups the right opportunities to succeed.

[zoxy]

On 6/14/2021 at 1:13 PM, keipop said:

But even then, despite all those barriers, at least 80% of my med school class this year is still white, have doctor parents, are very well off financially, etc., aka still the classic med student.

So even with it being supposedly accessible it's not actually accessible in effect.

Anyway, the only way to increase under-represented matriculants right now is to have separate application stream. Treating the root cause, lack of opportunity, is much more difficult and a long term solution rather than the band-aid solutions you described. Additionally the lack of opportunity is in the hand of the government and broader society, not medical schools. If you want representation right now in medicine, the only other way is having different admission procedures with different criteria and quota.

Any other objective system, MCAT, GPA, ECs, will end up disproportionately admitting wealthier and more connected applicants. So while you might think its gimmicky, different application streams/processes is the only way to have representation. Now is more representation worth subverting the current algorithmic application system to force the diversity issue in medicine? That's another kettle of fish that I don't want to wade into.

As a side note, even the most homogeneous and egalitarian societies like Sweden don't have much social and job mobility in the grand scheme of things. There was a cool study done by Gregory Clark, a professor of economic history and social mobility at UCDavis, that examines this.

As for forcing the issue of representation, you could either make it based off of SES , which would also benefit poor people of all races like in Manitoba and Saskatchewan, or you could make it explicitly based off of skin colour like QuARMS, Toronto, Alberta and Calgary. While SES points, rural points, and quotas might seem more gimmicky, I'd argue that it's better than the explicitly race based criteria that QuARMS, Toronto, Alberta and Calgary use. Also while explicit racial quotas have been ruled to be unconstitutional in the US due to the Regents of the University of California v. Bakke Supreme Court case, they're perfectly legal in Canada. Notice that I didn't say unconstitutional in Canada because Canada doesn't have a constitution.

I don't understand why they'd have a system where a child of wealthy black parents would have a leg up over a Hmong, Syrian, or Rohingya refugee but it seems like QuARMS, Toronto, Calgary and Alberta don't share my concerns. This is despite countless studies in the US has shown that race based affirmative action doesn't help poor Black and Hispanic folks. It mainly helps middle class and especially wealthy minorities gain access to elite education and job opportunities. So I think the Manitoba and Saskatchewan folks are approaching the problem better than Toronto, QuARMS, Calgary, and Alberta. 

Also medical school admission is a zero sum game. When Toronto introduced the Black Student Application Program, there wasn't a corresponding increase in class size. So with the number of black students going from 0-1 to 22-25, there were 22-25 other applicants who didn't get a spot who would have gotten one otherwise. Is that fair? I don't know.

As for OP, I wonder if they're an ESL learner. I've seen many ESL learners struggle with CARS despite scoring 130+ in the three other sections. I never understood the CARS obsession in a country where over 22 percent of people are foreign born and it has two official languages.

[bearded frog]

1 hour ago, zoxy said:

I don't understand why they'd have a system where a child of wealthy black parents would have a leg up over a Hmong, Syrian, or Rohingya refugee but it seems like QuARMS, Toronto, Calgary and Alberta don't share my concerns.

The issue is that while everyone agrees that admissions needs to me more equitable, there is not great agreement on how to do that. Everyone looks to objective factors (self-declared race, parent income bracket, etc.) that by themselves will never make things truly equal, because you end up treading very close to discrimination. As soon as you try to make things subjective then you run into problems, and people can claim discrimination, how can you say they are more in need than me, etc. I don't know of a good solution. I do know that there are at least admissions programs for indigenous applicants that looks outside the normal stats, which is good.

[1D7]

5 hours ago, Tullius said:

That's great, thanks for linking that.  Competitiveness of medical school admissions in Canada is so frequently exaggerated, on this forum and elsewhere.  I guess we can just use ~20% acceptance rate for the country from now on, with a higher rate for specific provinces.

I would argue it is more competitive than the 20% acceptance rate makes it seem, since there is heavy self-selection involved by the time people start applying. >90% of my premed class had the intention of applying to med school initially. Most people decide to do something else very quickly in their first 2 years of undergrad when they realize the grades aren't going their way.

[zoxy]

6 hours ago, bearded frog said:

Everyone looks to objective factors (self-declared race, parent income bracket, etc.) that by themselves will never make things truly equal, because you end up treading very close to discrimination. As soon as you try to make things subjective then you run into problems, and people can claim discrimination, how can you say they are more in need than me, etc. I don't know of a good solution.

I agree that there is no perfect solution for the issue, especially for subjective factors. But surely ignoring objective factors but singling out people by the colour of their skin is certainly not the best way to do it. Maybe I should have explained the Manitoba and Saskatchewan model a bit more.

For example the DSAAP for IP applicants at Saskatchewan looks at family income(different tiers for lowest incomes levels) in the past five years, your parents' education level, refugee background, whether you required social assistance growing up, being in foster care, being in a large family of three or more children, being the child of single parent household, being a single parent yourself, and being from rural Saskatchewan. You receive extra points if any of these apply to you. Manitoba's program is also quite similar.

Is this the perfect system that can make a level playing field? Of course not. But it at least addresses the issue by trying to identify and address all of the possible SES issues that could be holding someone back.

[anbessa21]

16 hours ago, zoxy said:

So even with it being supposedly accessible it's not actually accessible in effect.

Anyway, the only way to increase under-represented matriculants right now is to have separate application stream. Treating the root cause, lack of opportunity, is much more difficult and a long term solution rather than the band-aid solutions you described. Additionally the lack of opportunity is in the hand of the government and broader society, not medical schools. If you want representation right now in medicine, the only other way is having different admission procedures with different criteria and quota.

Any other objective system, MCAT, GPA, ECs, will end up disproportionately admitting wealthier and more connected applicants. So while you might think its gimmicky, different application streams/processes is the only way to have representation. Now is more representation worth subverting the current algorithmic application system to force the diversity issue in medicine? That's another kettle of fish that I don't want to wade into.

As a side note, even the most homogeneous and egalitarian societies like Sweden don't have much social and job mobility in the grand scheme of things. There was a cool study done by Gregory Clark, a professor of economic history and social mobility at UCDavis, that examines this.

As for forcing the issue of representation, you could either make it based off of SES , which would also benefit poor people of all races like in Manitoba and Saskatchewan, or you could make it explicitly based off of skin colour like QuARMS, Toronto, Alberta and Calgary. While SES points, rural points, and quotas might seem more gimmicky, I'd argue that it's better than the explicitly race based criteria that QuARMS, Toronto, Alberta and Calgary use. Also while explicit racial quotas have been ruled to be unconstitutional in the US due to the Regents of the University of California v. Bakke Supreme Court case, they're perfectly legal in Canada. Notice that I didn't say unconstitutional in Canada because Canada doesn't have a constitution.

I don't understand why they'd have a system where a child of wealthy black parents would have a leg up over a Hmong, Syrian, or Rohingya refugee but it seems like QuARMS, Toronto, Calgary and Alberta don't share my concerns. This is despite countless studies in the US has shown that race based affirmative action doesn't help poor Black and Hispanic folks. It mainly helps middle class and especially wealthy minorities gain access to elite education and job opportunities. So I think the Manitoba and Saskatchewan folks are approaching the problem better than Toronto, QuARMS, Calgary, and Alberta. 

Also medical school admission is a zero sum game. When Toronto introduced the Black Student Application Program, there wasn't a corresponding increase in class size. So with the number of black students going from 0-1 to 22-25, there were 22-25 other applicants who didn't get a spot who would have gotten one otherwise. Is that fair? I don't know.

As for OP, I wonder if they're an ESL learner. I've seen many ESL learners struggle with CARS despite scoring 130+ in the three other sections. I never understood the CARS obsession in a country where over 22 percent of people are foreign born and it has two official languages.

As a POC in the system, I could not agree more. I find that that race is all-to-often conflated with other factors, be it cultural diversity, or SES.

I grew up in an upper middle class suburb, far removed from my roots and cultural heritage. Though I appear overtly as a POC, my experiences and culture do not reflect this. I have little extra to offer marginalized and minority patients aside from the actual colour of my skin. I speak nothing but english. I do not know their culture. I have not lived their struggle. Someone of a different ethnic denomination who has underwent similar experiences related to immigration, finances, discrimination etc would have much more to offer ‘my people’ than I would. As much as I’d like to think that schools have moved towards inclusivity and diversity, part of me feels as though they choose those of us who are easiest to assimilate into the existing medical subculture, to be used as political fodder for grandstanding and improved optics.

[Snowmen]

On 6/14/2021 at 3:13 PM, keipop said:

But even then, despite all those barriers, at least 80% of my med school class this year is still white, have doctor parents, are very well off financially, etc., aka still the classic med student.

To be fair, that's not exactly surprising considering only 13% of Quebec's population is from a visible minority. Something else to consider is that once you're in medical school, it becomes hard to identify people who come from a wealthy background. For instance, a lot of people have inferred that I did because of the way I chose to spend my money (well, the bank's money...). In reality, I could hardly be described as being from a privileged or wealthy background.

What you're right about is that people from a privileged background do still get an advantage even if the current system does help make the process more fair.

[shikimate]

Race based stuff is a sexy political maneuver but I think somebody above already pointed out the difficulties because within a "race" there are so many nuances: how do you compare children of wealthy investor immigrants vs children of middle class skilled immigrants vs children of refugees if they are from the same country and same "race". how to do you compare children of parents who grew up in the country vs children of parents who immigrated to the country, if on the outside they appears to be the same "race". how do you compare somebody who have multiple racial backgrounds, but on the outside look resembles one particular race but not another race (eg. looks at Queens U uproar, if you have a great great great grandparent 100 years ago who was indigenous, do you still count as indigenous?)

Race is vertical division, whereas class is horizontal division. We have seen in former colonies that dividing people into little tribes (vertical division) help sow discord and fragmentation, especially if you purposefully make the borders muddy. Look at Pakistan vs India, the tribal conflicts in Rwanda, Suni vs Shiite muslims, etc etc. This is good if you want to be their overlord of course. 

[PrayingAsMuchAsICan]

On 6/15/2021 at 8:10 AM, anbessa21 said:

As a POC in the system, I could not agree more. I find that that race is all-to-often conflated with other factors, be it cultural diversity, or SES.

I grew up in an upper middle class suburb, far removed from my roots and cultural heritage. Though I appear overtly as a POC, my experiences and culture do not reflect this. I have little extra to offer marginalized and minority patients aside from the actual colour of my skin. I speak nothing but english. I do not know their culture. I have not lived their struggle. Someone of a different ethnic denomination who has underwent similar experiences related to immigration, finances, discrimination etc would have much more to offer ‘my people’ than I would. As much as I’d like to think that schools have moved towards inclusivity and diversity, part of me feels as though they choose those of us who are easiest to assimilate into the existing medical subculture, to be used as political fodder for grandstanding and improved optics.

This raises a really good point that overall it comes back to problematic political influences.

Both Canada and USA had institutionalized racial assimilation for BIPOC (e.g., Indigenous residential schools, Chinese Exclusion Act, labelling Asian Women as foreign prostitutes, etc.),  and to be honest, cultural heritage and original language is forcibly replaced and the "westernized culture" is subsequently past on into the future.

I agree that race is often conflated with other factors, but if we look towards the history of the foundation of this country, it really was race that forced the division and development of a labor system (i.e., slavery, discrimination Asian pay on the railroads, forcibly stealing of Indigenous lands, etc.) 

In my opinion, whiteness is a privilege in the western world and so is being wealthy. But more often than not, they are mutually inclusive with each other. 

[mdlifecrisis]

Lots of talk about the admissions process, but we shouldn't forget that medical training itself has a lot of discrimination. For example, clerkship evals are subjective and preceptors often don't have much time/care about truly evaluating their trainees, a lot of the eval is simply based off the initial perception of the student. In a process where there is little objective data (ex: no standardized exams, pass/fail, etc.), these subjective evaluations hold a lot of weight. 

 

[zoxy]

On 6/16/2021 at 12:30 PM, mdlifecrisis said:

clerkship evals are subjective

Yeah, I'm ugly and awkward so I can't swing for anything competitive. You can especially forget about Derm.

 

On 6/16/2021 at 12:30 PM, mdlifecrisis said:

little objective data (ex: no standardized exams, pass/fail, etc.)

Wish we had scored USMLEs like the US has.

[Persephone]

2 hours ago, zoxy said:

Wish we had scored USMLEs like the US has.

Oh man, I would never wish for this. Those exams are terrible. I never hear anyone have anything good to say about them. The fewer standardized exams I have to take the better!

[AB27]

Gimme USMLEs, being evaluated based on how much I "fit" into a program is seriously terrifying. I'm an introvert and not the popular type so low key scared. Especially because I am interested in surgery.

[bearded frog]

3 hours ago, zoxy said:

Wish we had scored USMLEs like the US has.

A standardized measurement is attractive, but there's a litany of reasons why standardized tests may not be equitable either. Pros/cons for everything.