Question 15: What can I do to improve my chances during this cycle?

Two words: Apply smartly. This in itself can be broken down to two rules. 1) Apply early 2) Apply broadly.

Let's tackle the second first. There is no such thing as a sure thing. No matter how many interviews at better schools you were offered, no matter how high your stats are, there is never a sure thing until you have the letter in hand. I have seen plenty of people get shot in the foot by not applying broadly. Never apply to only Top 20 schools. So much more than grades and your resume factors in at that level. You might get interviews at a dozen and only get accepted at one (I did), if any. That tends to be the biggest mistake for applicants with high MCAT scores. Just because you are in the 97th percentile of the MCAT doesn't mean diddly, because quite honestly there are at least 1000 applicants with as high or higher of a score than you! The schools have plenty of heavy hitters to consider, and at that point it all comes down to what they are looking for. The interview tends to be the make or break moment, but don't think that big pile of materials that you sent has been forgotten. It is never an even playing field, from start to finish.

I would personally recommend applying to about 15 schools. Try to break down your list so that 30% are reaches, 30% are about average (as best as you can see) for your stats and resume, and 40% which you deem less competitive. Quite frankly, the MSAR and other resources fail to really show the competitiveness, so don't underestimate those schools. Many of them pick up nontraditional or special circumstance applicants that often have low GPAs or MCAT scores. The traditional applicant tends to need a little more oomph. I'd shoot to be at least a point or two above the median for schools that you consider average at (0.2 GPA more would be nice as well). Consider applying to a few DO and MD schools, to really get a good range of schools (especially in state ones). If for whatever reason you choose to only apply to MD or DO, make sure to apply to all of the ones that are in state for you. Not only do they tend to be cheaper, they also often prioritize in state students during the cycle.

Now lets talk about applying early.

This quite honestly is probably the single most effective way to improve your competitiveness once the cycle has began, unless you are retaking the MCAT after a dismal score. You want to be the first application that is looked at, when every interview and every seat in the upcoming class is available to be offered to you. The longer you wait, the further down you fall in the pile, the more jaded the committee becomes, and the less opportunities for interview and acceptances are there. Most schools are what is known as rolling admissions, in which the school will offer seats to applicants during the cycle, rather than waiting until the end of the cycle. Some schools opt to be nonrolling, giving all of their seats at once at the end of the cycle. Theoretically, this means that every interviewee has the same shot. I am skeptical of this, as the committee is still meeting to discuss your application, and would still rather be the first than last to interview.

Ideally, you would want all of your secondary applications done by early August at the latest, well before interview season begins. Most schools don't offer the secondaries until about July 15th, so there is some wiggle room for those who might submit their AMCAS in mid or late June. If at all possible, devote as much time to essay writing and revisions as you can once they start to arrive, and don't hesitate to reuse essays. There is a trade of between revisions and time delay, so don't overly knit pick (which is of course difficult for pre-meds). The primary application essay is the most important (see one of the earlier questions to learn more about it), of course, so expect to put the most time into it. Whatever you do, don't put them off! I know people with 3.8+/35+ stats that bought the bullet on both interviews and acceptances by waiting until November or December to submit the secondaries. Try to interview early as well, if you are given multiple dates. You never get a second chance to make a first impression, but its also nice to be the first to make one!

The two biggest problems for future physicians (part 2)

So last time I rambled about the overuse of our health care system, now lets talk about the single biggest preventable drain on our healthcare system; obesity. The baby boomer generation has no choice but to be a big cost to our healthcare system, as they are old and we have made it so they can get older (unless we decided to "prevent old age" in a number of gruesome and dystopian ways). Obesity, however, is prevalent in all generations and ages, and is only becoming more common. It is really a fascinating problem, from an evolutionary point of view. We have done something that no species has ever accomplished, we have reached a level of dominance where our fitness literally does not matter. For the first time ever, people that once had disease and disorders that essentially prevented them from ever reproduced are now doing so. Bad recessive alleles are no longer being repressed as much. In the same way, we have also reached such a level of dominance and prevalence of food here in the Western world that we have the ability to gorge ourselves to obesity. Despite all of the wonderful mechanisms that our bodies have evolved to counter all sorts of problems, a mechanism to prevent obesity was not something that ever arose.

Why? Simply because it wasn't necessary. Abundances of food have occurred before, but ultimately if an animal got fat (assuming predators and omnivores here), they couldn't catch the food anymore. They would then starve until a point to which they were fit enough to catch food or die. Our obesity does not prevent us from obtaining food, due to the nature of being able to exchange food for money. Thus obesity can be a life long condition, rather than a temporary one.

So how does this effect the medical community? Cost. Obesity is an expensive chronic condition that costs lots of money to fix or mitigate its side effects. Heart disease, especially, goes hand in hand with obesity. Everyone knows about the health problems and thus healthcare related to obesity, but hospitals and our community have another problem. Just like our bodies weren't built to respond to rampant obesity, so is the current medical structure of our society not prepared for obese healthcare. Hospitals were not BUILT to handle the super-morbidly obese patients that are now rolling in (no pun intended). I've seen an obese person on a extra large rolling bed get stuck in an elevator and go into cardiac arrest. He was literally too fat for the hospital, and the doctors trying to get a crash cart into the elevator were more than happy to comment on it. I watched a surgery on an obese man recently. It was an intestinal surgery and the longest part of it involved simply getting through the fat to the target. After the fat clearing, the surgeon turned to me and said "I just go paid 700 dollars for cutting fat." Mark my words, smart hospitals will be soon instituting a midlevel specialist who's sole job is to clear fat out of the way for surgeons. I'm sure that this is just one of the many things that will need to change in order to make hospitals economically and physically viable for our obese future, and there are many people hard at work at the problem. Do you think its a coincidence that newer hospitals have much wider hallways and bigger elevators? I wouldn't be surprised if fellowships in Obese Medicine start popping up sometime soon.