Draped in scrubs, 13-year-old Adam Kassam peered intently over a sterile sheet into a man’s open chest cavity. He stood spellbound at the head of the patient, next to the anesthesiologist, listening to the surgeon’s play-by-play of the triple coronary bypass procedure. Eight years later, the memory is still fresh in his mind.
“It was just one of the most amazing things I’ve ever seen. To see the heart actually stopped— that means that you’re seeing death. That’s death on the table,” he raves on the phone from Cornell University in Ithaca, New York, where he’s holed up at Uris Library, working on a neurobiology assignment.
Adam, a Toronto native, was volunteering in the Patient Care Unit of Sunnybrook Hospital when his supervisor talked a surgeon into letting him in the operating room. Everyone in our high school class knew he was keen on medicine: since childhood, when his family doctor would let him play with the stethoscope, Adam has wanted to be a physician.
He has plenty of company. In an era of millionaire entrepreneurs and instant celebrities, medicine seems like the proverbial turtle of careers: a slow-but-sure path to wealth, prestige, and security. Other lucrative careers—med applicants often cite investment banking and engineering— offer quicker payoffs and potentially higher salaries, but thousands still feel the lure of the MD.
Gaining entrance to club med is a marathon, and one of the first trials of endurance is the application. Of the 10,673 applicants to Canadian medical schools last year, one in four received admissions offers. The odds are tougher within Ontario, where only one in seven applicants was enrolled. Non-Ontario schools impose limited quotas for out-of-province students, leaving a greater pool of Ontario hopefuls to battle it out for a spot in-province.
The six Ontario schools accept a common application through a one-stop website, the Ontario Medical School Application Service, beginning in July. It might be good preparation for the cumbersome paperwork that doctors are saddled with, but the process is still a painstaking exercise. The autobiographic sketch component, for example, is “a comprehensive list of the pertinent details of your activities since age 16” that should include experiences “both structured and non-structured.” For verification purposes, applicants must list a contact for each activity. Some schools have supplemental requirements. The University of Ottawa, for example, demands level-C CPR, a police record check, and an immunization record. OMSAS closes Oct. 1— no exceptions.
Then comes months of waiting as committees whittle thousands down to hundreds for the allimportant on-site interview—where candidates are grilled on personal merit and quizzed on their stance in controversial issues such as abortion and euthanasia— which takes place in March or April. At U of T, interviewees are granted an hour alone with a faculty member and a med student, who have volunteered their precious weekend hours.
Interviewers want what’s best for the candidate, says Dr. Viren Naik, an assistant professor at U of T and an anesthesiologist at St. Michael’s Hospital. “You think they’re being harsh or being difficult, but that’s not it at all,” he says. “There is a sense of déjà vu and there’s a brief period of anxiety, because it brings out the same emotions you had. You forget that you’re on the other side of the table for the two seconds.”
Adds Dr. Naik, “When you’re going into medical school, that hurdle seems massive. Once you’re over that, the next one is residency. The hurdle that always seems to be the biggest is the one in front of you.”
For the majority of applicants, the biggest hurdle is scoring an interview at all. Nobody enjoys writing 300 words on topics like “Why are you a self-directed learner?” When all the hard work and sacrifices from years of undergrad are dismissed with a generic rejection letter, it’s hard not to take it personally. Aside from academic cutoffs based on GPA and MCAT scores (the Medical College Admission Test is required by 11 out of 16 Canadian schools), rebuffed candidates receive no feedback on why they weren’t chosen.
“I think a lot of people would call it demoralizing, offering every aspect of your life for the last five years for some faceless institution to judge, only to be deemed lacking,” writes Weija Chiang in an email from Japan, where she has been teaching English for a year after her applications yielded no offers.
“Med applications become more than just your acceptance into one school in one province in one country at one certain point in time. They become six months’ worth of self-doubt. It shouldn’t, but it makes you feel like a secondrate person.”
If the application process seems extensive and disheartening, keep in mind that the reward is even more schooling—up to 10 years more. Before they can start practicing, med school grads must be accepted into a residency program (which can last from two to seven years, depending on their specialty) and pass province-specific board exams.
And med school ain’t cheap, except for Quebec residents, who pay less than a quarter of the Canadian going rate. In Ontario, the tuition ranges from $48,695 for McMaster University, the only three-year school, to $67,448 for the University of Toronto. According to the 2004 National Physician Survey, conducted by the three major medical associations in Canada, 46 per cent of Ontario med school grads carry a debt of over $80,000.
Not surprisingly, the massive up-front commitment required for a far-off prize leads many to re-evaluate their childhood ambitions. Writing from Hong Kong, Karin Chu lists the disadvantages of being a doctor: long hours, compromising family and social life for patients, and an income ceiling that pales in comparison to other high-powered careers.
Karin, a U.K. citizen, declined med school offers from Bristol University and University College Dublin last year. “I’m not Mother Theresa. I’m just a normal and very practical human being—dedicating my life in service to other people would be more than I could chew.” She doesn’t have true passion for medicine, she says, and an MBA would better suit her personality: “I’m more of the kind of person that likes to put in the least amount of investment for the maximum amount of return.”
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There is no question of an alternate career for Adam, who says the sacrifices are worth it. Between the research lab, volunteering with Cornell’s Emergency Medical Services, travelling, and keeping up that GPA, it’s hard to see how Adam has time for, say, fun. But he doesn’t see it that way: “As a doctor, you pull 130, 140-hour weeks. Your personal social life is sacrificed. You learn that at a young age. No one’s pointing a gun to your head and saying you have to do this.” Besides, he adds, hockey, long walks, and a recent addiction to Celebrity Apprentice help keep him sane.
He has applied to 22 medical schools (“an average number”), 17 in the U.S. and five in Canada. “It’s basically consumed my life for the past seven, eight months,” says Adam, who sketched out a timeline in the summer, budgeting a month for the primary applications that are common to all American schools and another six weeks for secondary, school-specific ones. He spent around $2,000 U.S. on processing fees alone, not counting plane fare and accommodation for oncampus interviews.
“Being a doctor is a lengthy and draining process. You go into debt—I’m going to be six figures in debt when I’m 24,” he says matter-offactly. “You have to know 100 per cent without a shadow of a doubt that you want to be a doctor.”
Passion may drive candidates to keep going, but getting in takes a concentrated and organized effort. As one advisor told Adam, “The application for med school starts the first day you come to college.” And if rewarding experiences also fortify your application, so much the better. “Going abroad is what I wanted to do,” says Adam, “so I built my application around having international experiences.”
Last year, during an exchange at King’s College in London, he watched another triple bypass with the same fascination as when he was 13. Nor is London the only international item on Adam’s CV: he has worked on an HIV/AIDS education program in Bungoma, a rural town in western Kenya, and shadowed doctors in New York and Toronto. It’s important to gain experience in the field, he tells me earnestly—not to convince the admissions committee, but to make sure medicine is really for you.
The thing is, an astronomical number of people know that medicine is for them, including every premed in Adam’s class: “You have to be on, all the time. You’re in an environment that breeds competition—that atmosphere is contagious.”
Rumours abound of chapters ripped out of textbooks and sabotaged lab experiments, but no one I spoke to had ever witnessed such underhanded tactics. The competition manifests itself in subtler, quieter ways: in the crowded study areas, the long lines for office hours, the shelves already cleared of reference books five minutes after the library opens. The apprehension of not measuring up becomes intolerable, as the application process is often a solitary one. On Internet forums, such as premed101.com or studentdoctor.net, applicants bolstered by anonymity post their vital stats and seek feedback about their chances.
“I put pressure on myself to do well,” Adam says. “People thought I was one of the most neurotic people around in high school.” Neurotic is how I remember him, the one asking informed questions about cellular respiration while most of us squinted at the overhead projector and hurriedly copied notes in between bites of lunch. Holding forth on life-transforming experiences and what he hopes to accomplish in global medicine, Adam sounds as inspired and polished as his dozen-and-a-half admissions essays must have been. But a note of anxiety creeps in when I ask about his chances: “You learn very quickly that it’s a game, it’s a crap shoot. You really don’t know how well you stand in this admissions game. It really is knowing the rules four years in advance, knowing how to apply.”
Though hesitant to name schools, he says he has completed a few interviews in the U.S. and has a couple of Canadian ones coming up. “I’m hopeful. It’s been a trying time because it’s something you’ve worked your entire life towards. To have it crystallize in such a small amount of time, and say to yourself, ‘Am I good enough? Is this something I’m going to be granted the opportunity to become?’ The fear is paralyzing.”
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Cardiology,” Nadia Khosrodad promptly replies when I ask what she’d like to specialize in. She then pre-empts my next question: “Obviously you want to know why, right?” The “why” is personal. When Nadia was in grade 10, her dad had his first heart attack. “My sister’s knowledge pretty much saved my dad’s life. If she hadn’t intervened, they would have never have called the doctor on call to have surgery that night. I’ll never forget—I was there when my sister made that call.”
Medicine runs in the family: Nadia’s older sister, Nasim, entered the University of Alberta’s residency program last summer. Her uncle, a close family friend who died in a car accident, was a cardiologist. “That’s one of the first reasons why I’m passionate about the field,” she says. “I don’t want to get all sentimental on you, but if you’re not caring, you’ll only be a halfphysician.”
A high school shadowing experience strengthened her aspirations, but when the transcripts from an exchange stint in France didn’t arrive on time last year—“You were lost in our system”—Nadia couldn’t complete her med school applications.
“I think the correct way of saying it is I almost went insane,” she recalls. “I knew what I wanted, I focused, and I did my best from year one. All of a sudden it all crashed. I probably wouldn’t be able to talk to you if you were to ask me these questions then, I’d be swearing. It took six, seven, eight months for me to calm down, but now I can talk about it, and find my way back to where I was.”
With her applications derailed and graduation looming, Nadia found herself flying by the seat of her pants for the first time. “The funny thing is, I never thought it would be do-or-die. I always told myself, plan A is medicine after fourth year, but make sure you have plan B all the way to Z. In September 2007, when I found out, OK, this isn’t happening for next year, that’s when I realized I had only plan A in my heart.”
Working as a community advisor in residence gave her the energy to bounce back. Nadia, who has a habit of referring to her charges as “my kids,” perks up as she describes bowling trips and late-night talks. She’s applied to an advanced nursing program at McMaster and says she might work for a few years before trying for med school. “If I don’t get into that,” she laughs, “it’s going to get interesting.”
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“Take lots of time to prepare your application and get it in on time—becoming a doctor isn’t a last-minute decision,” advises Dr. Maureen Shandling, director of admissions to U of T’s faculty of medicine. Somewhat of an understatement, but for shrewd applicants, the application process—and mental preparation for rejection—starts a year early.
Third-year McMaster student Rahul Nayak scored no interviews at the four schools he applied to this year, but he doesn’t mind dropping $500 to familiarize himself with OMSAS. “Even though I didn’t get in this year, I don’t regret it, because I did learn how the system works,” he says. Rahul is gearing up for a more extensive application in the next cycle and plans to go into research—“infectious diseases are a fancy for me”—if med school doesn’t pan out.
Spandana Bestha, in her third year at U of T, also took a trial run at applications. Though she has no interest in practicing there, she applied—and got into—schools in India “just to see if I can.” Spandana has already written drafts of her autobiographical sketch and plans to revise it at her leisure over the summer. Her fallback career? Pilot. She has already taken classes at a Brampton airfield, testing out a small Cessna.
The backup plan is common counsel: when the odds are against you, you don’t want to be left hanging. But even as they embark on other careers, those with their hearts set on medicine dust themselves off and go back for more.
After a year-long break from the med school grind, Weija, for one, is ready to re-apply. “At certain points in the last couple of years, it has felt like that one goal had consumed every other part of my personality,” she says. “It’s a wonderfully liberating experience to find that you’re still a person aside from it, and you can even be a happy, successful person.” And she’s also considering teaching: “It has the same kind of human interaction and community contribution I was looking for in the first place.”
Alex Lee, a U of T chemical engineering grad, found work as a systems manager at Proctor & Gamble but still hopes to be a doctor. “I’m interested in the human body, I like being a leader, I like applying science in practice,” he says. “Medicine is the focal point of all my passions.” Alex is faring better on his second try: he has an interview at the University of Western Ontario in April.
Repeaters like Weija and Alex numbered over 3,400 last year, making up a third of Canadian applicants. Eighty-four of them had, astoundingly, applied for five years in a row. For her part, Nadia seems upbeat about taking the long way—her sister Nasim, as an Iran-trained doctor, went through eight years of testing, certification, and applications before entering a residency program.
“If you really want this, if you really put your ass into it, if you’re smart about your decisions—and hopefully, if I haven’t been thus far, I will be in the future—you will make it,” Nadia says. “There is no ‘die.’ You only have the option of ‘do.’”
