Approximately 60,000 medical school applicants will be finishing a nearly year-long admissions process this month, close to the second anniversary of Dr. Lorna Breen’s suicide. Breen’s untimely death in 2020 inspired a new law to provide funding for preventing burnout by improving mental health treatment and promoting resiliency of health care providers.
This new law won’t prevent physician burnout. Before the first day of medical school, aspiring doctors have already been exposed to prolonged toxic stress from an admissions process that extends over a 12-month period, during which their future is in the hands of medical school administrators.
Even though doctors are leaving medicine because of an all-time high rate of burnout, U.S. medical school applications increased 18% in the past year and 86% since 2002. But fewer applicants are getting in, at least on the first try, because the dramatic rise in applications has led to lower acceptance rates. Last year, only 38% of applicants were accepted, compared to 45% in 2012.
The medical school admissions timeline puts future physicians under stress and exposes them to self-doubt for long periods. On the online forum Student Doctor Network, the despair is palpable. One wrote, “My stress levels every Thurs/Fri are taking years off my life at this point. I just wanna know one way or another.” Another recently posted: “Been on waitlist since January. Everyday is a struggle.”
As a physician and mentor to medical school applicants, I’ve seen this stress at work. I’ve also seen it at home — two of my children went through the application process and are now in medical school.
Medical school training promotes self-sacrifice over self-care. Nearly half of medical students experience burnout and, before their professional education even begins, start to experience deleterious effects of stress, which continue and are amplified during medical school. A 2012 study showed higher emotional exhaustion, a symptom of burnout, in premedical students compared to non-premedical students. In another study, 33 Black and Hispanic medical students interviewed from across the country described medical school admissions as “very negative” because it was overwhelming and required “extensive investment of time.” A 2020 online survey found that 73% of 556 medical school applicants had depression or anxiety symptoms, with half reporting uncertainty related to the application timeline.
The lengthy admissions process, which opens this year on May 3, means hopeful med-students-to-be spend at least a year before medical school languishing in toxic stress. For starters, the application process is expensive — on average, students apply to 18 schools. The centralized American Medical College Application Service (AMCAS) application costs $170, plus $42 per school. Most schools then invite applicants to submit secondary applications for an additional fee of around $100 each. This is after potentially spending thousands of dollars on preparation for the Medical College Admission Test (MCAT), the standardized multiple-choice exam required for applying to medical school. And none of this includes the indirect costs, like missed opportunities for higher paying jobs.
This time-consuming and expensive process is futile for many, since most applicants don’t get into medical school each year. While a lucky few receive early acceptances in the fall, about six months after applying, the rest wait months longer to learn if they have been accepted, rejected, or relegated to the uncertainty of waitlists. Some schools take up to half of waitlisted applicants, but most waitlist spots don’t open until May — just weeks before medical school starts in August and days before the next application cycle opens in June. This year, more than 15,000 applicants were re-applying for a second or third time.
The Association of American Medical Colleges (AAMC) governs the medical school admissions process through so-called traffic rules to ensure applicants receive “timely notification” of acceptances and medical schools don’t have unfilled spots. These rules aren’t just designed to keep things running smoothly; they also seek to prevent medical schools from blocking the road for some applicants. The problem is that these traffic rules, as currently implemented, can’t stop the large pileup of people near the end of the process who are anxiously awaiting a green light so they can move forward.
Medical school admissions take more than twice as long as undergraduate and other graduate admissions that use similar holistic review processes as medical schools. A shorter timeline would likely empower applicants by returning some of that time — and therefore control — to their lives. There doesn’t seem to be a good enough reason to keep the medical school application process this long; the AAMC doesn’t have an explanation for why it needs to take a year.
Although a shorter timeline might just consolidate the application-process stress, reducing the timeline would at least release the people who won’t get accepted to make plans to re-apply or move on. For those who do get in, it would provide more time to transition to medical school, such as finding housing and moving.
The medical school application process adeptly and rapidly changed during the Covid-19 pandemic by switching interviews from being in-person to virtual. Although the main purpose was to prevent the spread of infection, this change ended up saving applicants thousands of dollars in travel costs and untold hours of travel time.
Reducing the extreme stress experienced by nascent physicians should be as much of a priority as preventing disease spread. Shortening the admissions timeline would be an important step toward preventing burnout of the next generation of physicians.
Anne N. Thorndike is an internal medicine physician at Massachusetts General Hospital, a mentor to premedical and medical trainees, and an associate professor of medicine at Harvard Medical School.