Medical Examiner

Med School Hopefuls Shouldn’t Have to Jet-Set

The on-campus interview is an expensive and unfair part of the application process. It finally might be changing.

A woman in scrubs with a stethoscope takes notes.
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Sarah Householder spent her senior year of college crisscrossing the U.S.: from campus in Connecticut to New York (thrice), Illinois (twice), Minnesota, Maryland, Wisconsin, Georgia, and, each time, back again. At the time, Householder led her college’s premier all-female a cappella group with her jazzy soprano voice. But she wasn’t touring—and she hardly had time for harmony. The impetus behind her jet-setting lifestyle? Getting into medical school.

Householder, now a third-year at Columbia University’s Vagelos College of Physicians and Surgeons, applied to 21 schools—just four above the average—between August 2017 and February 2018. She was lucky enough to interview at 11, usually flying out on short notice. She kept packing her suitcase time and again in hopes of getting in and, more importantly, getting a good financial aid package. “The biggest thing I remember is the time, just how much time it took,” says Householder. The “interview” isn’t so much a conversation as a multiday ritual, consisting of travel, panels, meals, tours—all during which prospective students are observed by the admissions committee—in addition to the actual formal answering of questions. Second to time, all this travel takes a lot of money: Householder tracked nearly every penny she spent on applications on a spreadsheet. Between August and October alone, she spent $905 on interviews, “Spirit: Traveling - Chicago: $292,” “Ann Taylor; Blazer - Interviews, $55.30,” “Uber, Travel in Michigan, $34.92”—the list goes on.

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Why apply—and then pay to visit—so many schools? Medical school acceptance rates are low; only 41 percent of applicants get in anywhere. As multiple applicants I spoke to explained, most applicants are rarely, if ever, in a position to turn down an interview offer. That was especially true this year: With a record surge in applications this last cycle, interview offers were more valuable than ever. But they also were less time-consuming, less expensive to attend, and therefore a little bit fairer and easier for doctor hopefuls who can’t shell out (and perhaps also skip hours at work) to try to impress committees. We can even hope that one small piece of the medical school industrial complex has been toppled for good.

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This is all because the interviews this year, as so many things did, went virtual. A typical remote interview experience looked something like this: a welcome Zoom call in the morning, a Q&A session with students and/or faculty, a financial aid panel, a tour video, and two interviews (20–40 minutes each) with faculty. The whole thing could be completed from a dorm room, in a presentable top and sweats, and was over in a few hours.

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By and large, it worked. “I was really concerned that [our interview day] would be hard to translate to a virtual platform,” says Mark Yeckel, associate dean for admissions at the Frank H. Netter MD School of Medicine at Quinnipiac University. “It’s gone better than I could have ever imagined.” In fact, every admissions officer I asked said they were left something to the effect of pleasantly surprised. “Assuming that everyone has the equipment they need, [the remote process] is very efficient for both the candidates and the admissions committee,” says Demicha Rankin, an anesthesiologist and associate dean of admissions at the Ohio State University College of Medicine. Rankin noted that the reduced financial burden on students was significant.

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I didn’t have to look far to find applicants who were pro-virtual interview. I asked how the process had gone in a forum on studentdoctor.net, one of the central hubs for pre-meds to share information. The responses were overwhelmingly positive. Virtual interviews save money: “I make about $16/hour working as a full-time worker in clinical research at a large academic medical center,” user BeingForItself wrote. “Because interviews were virtual, not having to worry about paying for flights, hotel stays, or paying for food while traveling helped a lot.” Virtual interviews save time—potentially, lots of it: “I live in rural America, 7 hours from the nearest large airport,” a user identifying themselves as back2skewl added. “Virtual interviews were quite frankly the only reason I had such a successful cycle.” A user identifying themselves as anotgramnegative was able to continue their work as an “ICU RN who worked extensively with critically-ill COVID+ patients” without interruption throughout the application cycle. The virtual aspect “allowed me to take a travel job across the country and do interviews,” they wrote. (Virtual interviews even save lives!) On the negative side, one user argued that reduced frictions to interviewing make it easier for the most desirable applicants to hoard interview spots, since they can accept all of the interview offers they are given; but it’s long been a concern that applicants who can afford all the tickets will do this anyway.

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It makes some sense that interviews traditionally required travel. Before webcams, if you wanted to talk to someone and see them too—and have them see your campus—you had to meet in person. That is no longer the case, and it hasn’t been for most of this millennium. So why did in-person interviews persist? Part of the answer is just that things never had to change, and thus did not change. But it’s also that interview days aren’t just about the interview, or even giving faculty the opportunity to chitchat with candidates casually. Interview visit extravaganzas give schools an opportunity to reel in the candidates they want most. Multiple admissions officers I spoke with expressed a fear that remote interviews could disadvantage less prestigious, newer, or more rural medical schools which use them to woo top-tier applicants. “Quite honestly, it hurts a school like us,” says Yeckel, of Quinnipiac. “We’re a new school, we’re a young school, but we have a really, really good teaching and learning facility. So when [applicants] don’t see that, it can make it a challenge to recruit people.” But even the prestigious schools like to woo too. Johns Hopkins School of Medicine, Paul White, assistant dean for admissions, told me, cherishes the opportunity to dispel “myths” about Baltimore.

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This is not a good enough reason, in my opinion. Interviews in future application cycles should stay remote. If schools really want the opportunity to endear students to their stomping grounds, they can invite successful applicants to visit after they accept them, as many already do with “Second Look” days. Ultimately, tons of people want to be doctors, and a budding pool of applicants competing for a lagging number of seats means that more and more applicants who would make perfectly good doctors won’t be accepted anywhere. This fuels an admissions arms race where applicants do (and for those who can, pay) just about anything to get in, and all too often, the ability to pay is conflated with enthusiasm—or worse, aptitude. “There is a broad infrastructure that now exists to extract money from trainees in medicine, from the schools to the licensing exams, to the licensing authorities, to the board certifications,” Bryan Carmody, a nephrologist, assistant professor at Eastern Virginia Medical School, and prolific medical blogger, told me. “And it exists because it can.” It might be no surprise at all that 51 percent of medical students come from the wealthiest quintile of households, with 24 percent from the top 5 percent alone. While the interview process is hardly the biggest of the many, many problems in American education that mean most doctors come from wealthy backgrounds, it is a cog worth removing. Keeping the interview remote would help dismantle one small—but meaningful—part of the larger infrastructure that prevents America’s doctors from reflecting the population they serve.

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And there’s hope that it will stay remote. On March 23, an admissions officer surveyed the private AAMC Group on Student Affairs listserv regarding plans for the next admissions cycle. The results, shared with me by a listserv member, are promising. Of 64 officers who responded on behalf of their schools, one will hold in-person interviews. Two are undecided. Three will be hybrid, which is good, but not perfect. (As Yeckel, among others, told me, students will likely perceive that shelling out to show up in person will give them an edge, even if schools promise it won’t). Encouragingly, four are probably remote, and 54 are remote—which is to say, applicants will have so many fewer flights to schedule and days of their life to miss. But this upcoming cycle is still being planned with the pandemic in mind. It’s the one after that will be the real test.

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