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Over the past year, college students have been inspired by medical and public health professionals working tirelessly throughout the Covid-19 pandemic. According to the Association of American Medical Colleges, medical schools in the United States have seen a 17 percent increase in applications so far, with the average yearly increase in applications usually at less than 3 percent. Geoffrey Young, a senior director with AAMC, called this uptick unprecedented.
“I’ve always known that I wanted to go to medical school, but the pandemic has made it incredibly clear that medicine is the career path [for me],” said Maddie Burton, a current senior at Northwestern University. “One night at the very beginning of quarantine, my family sat at our dinner table talking about all of the health care workers trudging through this nightmarish situation. I recognize the turmoil these heroes are [dealing with]. I understand why, and I know I would volunteer myself to do the same. I want to do whatever I can to help people through their toughest times. If that means throwing myself into the center of a life-threatening pandemic, I would do it.”
But as applications increased during the pandemic, the available spots at medical schools have not, making the programs even more competitive. As Young explained in an e-mail to The Nation, “Teaching resources and the intensive nature of medical education make it very difficult to increase class size.” This has led to the average GPA and MCAT score’s being driven up, making medical school less accessible than ever before.
These trends are worrying for Burton. “It’s hard not to look at my application and see imperfections as roadblocks that I’ll completely stumble over trying to get a medical degree.” Some steps have been taken to increase medical school enrollment, but the number of residency positions currently grows at 1 percent a year, a number too small to result in any meaningful impact. Another recent AAMC study predicted a shortage of up to 139,000 physicians by 2033. Along with Covid-19—which has compounded the macrotrends already contributing to the physician shortage such as an aging population, population growth, and retiring physicians—the shortage has left some hospitals without beds to spare.
The pandemic has also made receiving practical skills more difficult, with many premedical students worried that their applications remain incomplete. “With Covid, I couldn’t get any of the clinical experience that I wanted to after graduation,” said Cary, a recent graduate from Vassar College. “I’ve heard so much about more people applying because of Covid so it’s already going to be harder to get in, and now I’m feeling more stressed about my application.”
This intensified anxiety has led some to reconsider going to medical school altogether. “I’m just unsure about my decision to apply because there’s so much I couldn’t get done because of the pandemic,” Cary said. The 23-year-old is working as a researcher in New York now, and is hoping to find clarity in the coming months.
Violet Tan, another recent Vassar graduate, expressed similar frustrations. “Covid has affected the quality of my medical school application in that I have not been able to do clinical volunteering and I know you really need that to get in,” Tan said. After taking a gap year, Tan said she feels more pressure to add experiences such as getting publications in research to make up for the lack of clinical hours on her application.
For many premedical students, the economic impact of the pandemic has been incredibly disorienting. Some of them, who originally hoped to take a gap year to work and save money prior to applying to medical school, felt rushed by the lack of job security into applying earlier. “With Covid, I have had friends get job offers retracted and also friends who could not start their jobs on time,” said Robert, a 23-year-old who recently graduated from Harvard University and is currently working as a health care consultant in Massachusetts. “If it were the case for me and I [got an offer retracted], it would have influenced my decision and I would have applied earlier.”
The consequences of the economic recession following Covid-19 extend beyond individual students’ applications and could be responsible for a new cohort of doctors with less training. This shift could alter the medical school model as we know it and create new barriers to becoming a physician. While the first two years of medical school take place in classroom settings within the institution itself, the latter two involve clinical training that takes place in separate teaching hospitals, referred to as clerkships. This training has been paused in many parts of the country during the pandemic, with schools citing the fact that students lack the official status of essential worker, as they introduce more cost and risk than value to the clinical setting.
Without in-person clerkships, students who graduate and move forward in their medical education lack many of the skills needed to excel in residency, such as performing clinical exams that cannot be recreated via online learning. In addition to liability, many clerkships have been put on hold because of a lack of resources. Clerkship sites do not have enough space to accommodate more students, so it is almost impossible to increase medical school class size enough to make a difference in the physician shortage. Since schools are dependent on clerkship sites for their students to complete training, they have to match their class sizes spot-on with the spaces in these clinical training sites. This is imperative so that schools don’t end up in the position where they “find that they can’t adequately train [all of their] students,” as Young stated in an AAMC online article in October.
Some medical schools have allowed students who have not completed their four full years of training to graduate, beginning their work as residents in the internal or emergency medicine departments. The Grossman School of Medicine at New York University became the country’s first medical school to enact this plan in March 2020, announcing that it would graduate its students three months earlier than originally intended. The Liaison Committee on Medical Education approved this arrangement, as long as students have met the overall objectives for their medical education. In addition to New York University, at least 24 other schools, including Harvard and Rutgers, have allowed their students to do the same.
This decision has been controversial. While everyone can agree that more doctors are needed immediately, the medical system is generally designed to limit the responsibilities of inexperienced doctors so that they can continue learning in new, high-pressure environments. Instead, early graduates of medical school are being forced to step up and do things in the hospital that they would normally not do on their own.
Instead of graduating medical students early in times of crisis, why not invest in creating more physicians to preempt such circumstances? The answer can be partially traced back to 1997, when Congress instituted a cap on Medicare-funded residency positions. As a direct result of this cap, even if medical schools could significantly increase enrollment—unlikely given the lack of clerkship sites—medical school graduates would still be unable to become doctors, because they must undergo additional training in residency programs in order to actually practice medicine.
Even medical school deans have expressed concerns about the lack of resources and residency spots: Forty-four percent were worried about their own incoming students’ ability to find residency positions of their choice after graduation. Prior to the pandemic, 85 percent of deans had also indicated unease regarding the availability of clinical training sites, reporting that there was competition for sites from other health care professional training programs. Ultimately, more resources would allow aspiring medical students like Burton to realize those goals, enable current medical students to continue clerkships during the pandemic, and retain the four-year medical school model so that future patients do not suffer from their physicians’ lack of experience. It is critical to address these concerns now in the midst of one pandemic and before the next begins.