http://www.nytimes.com/2011/04/02/health/02resident.html?_r=1&hp

I must admit I was happy to see that the University of Pennsylvania had kept its lead on Johns Hopkins for the #2 spot for the 2012 U.S. News list of best medical schools. What does this really mean? Nothing, of course. Both remain fantastic medical schools, with excellent faculty and graduates who have access to the best residency programs throughout the country.

The critical question for pre-medical students should not be “what is the best medical school” but rather “what is the best medical school FOR ME?” No matter how much effort U.S. News puts in to their medical school ranking algorithms, they will never be able to answer this question for you.

Want tips or advice? Contact me at flynn@prepera.com to learn what I can offer you.

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Medicare vs. Medicaid — All you really need to know!

You should have basic knowledge of the two largest government-sponsored heath care programs, which are Medicare and Medicaid. It is not uncommon to be asked to explain the difference between the two or to be asked what challenges each are facing.

Medicare: Medicare is a federally-sponsored health insurance program that pays for care for the elderly and certain groups of disabled people (the most important being dialysis patients). Medicare is broken into Parts A-D, however you do not need to understand the particulars of each (basically, each part pays for a different service). Medicare is the single largest health care payer in the U.S. and will continue to grow in size as the population ages and more people become eligible for Medicare benefits. Medicare pays predetermined rates for each service provided to a given Medicare beneficiary. This rate is typically slightly below what health care providers (physicians and hospitals) calculate it costs them to provide the services rendered. Thus, many providers believe that they lose money by serving Medicare patients. The rate paid by Medicare is almost always lower than what is paid by private insurers (if a certain service is calculated to cost $100 to provide, Medicare may pay $98 for it, though private insurers may pay $120). Thus, providers depend on private insurance to make up for an losses on Medicare and to earn a profit. Not surprisingly, some physicians no longer accept Medicare, decreasing patient access to these providers.

Key points: Medicare: federally funded, insurance for the elderly, growing rapidly with aging population.

Medicaid: Medicaid is an insurance program for low-income individuals. Each state sets up and manages its own Medicaid program, so the eligibility requirements and services covered vary from state to state. Thus, it is difficult to make generalizations about Medicaid due to state-to-state variability. However, nearly all Medicaid programs are underfunded, worsened recently by high levels of unemployment and massive state budget deficits. As a result, Medicaid patients generally have significantly more restricted benefits than those covered by private insurance or Medicare. Moreover, reimbursement is much lower than both Medicare and private insurance. Thus, many providers no longer accept Medicaid, creating widespread access problems and frustration for Medicaid recipients.

Key points: Medicaid: state funded, insurance for the poor, growth due to high unemployment, access issues.

Summary: If you understand the differences between Medicare and Medicaid, you will be prepared for the majority of health care system questions that you could be asked. Please see my post on health care reform for more essential information you need to know before your interviews.

I am beginning to believe that the motives of these companies is much less altruistic than I previously assumed. My students do significantly worse on these free practice exams (MCATs) than on other available practice materials. My classmates at Wharton tell me that they did significantly worse on practice GMATs, regardless of when they took the free exam (ie, before, during, or at the end of their GMAT preparation period). Why would this be? Perhaps these free exams are simply harder than the purchased practice materials. Possible, but this would not explain the differences in scoring — standardized exams are curved, controlling for the effect of test difficulty.

One can only conclude that these scores are kept low intentionally. There are two not-so-obvious reasons for deliberately mis-scoring these exams.

1. Guarantees: Many test prep companies offer money-back guarantees for students who do not improve after purchasing an expensive tutoring/prep package. The practice test often serves as the pre-instruction benchmark. Keep that score artificially low and students will appear to have improved, regardless of reality. The stakes involved are huge — often more than $1000/student, so these companies have clear incentives to honor as few of these guarantees as possible.
2. Fear. If an intelligent and well prepared takes a practice MCAT and scores a 32, she is unlikely to sign up for an expensive course. Knock that score down to a 24, and she might panic, signing up for the course on the spot!

Do I have any hard evidence to support this assertion? Admittedly, I do not. But I encourage my readers to help me gather the necessary data to analyze this apparent phenomenon.

Prepera readers: Join the discussion. What do you think about changing the requirements for medical school admissions?

Check Prepera.com regularly for future articles about medicine and medical school by Prepera authors.

When should I submit my medical school application?

Pre-medical students ask me this all the time. While the answer is, as you might expect, unique for every student, in this post I will provide the best possible advice on submitting your AMCAS application.

The Prepera Rules: Submitting your AMCAS application (a guide for medical students)

1. The Sooner the Better. Ok, fine, everybody already knows this. But it is worth repeating! The sooner you submit your medical school applications, the better your chances for admission to any given school. Do not delay unless you have good reason to do so. You have worked hard for years to get to this point, do not sabotage yourself by procrastinating.
2. A rushed application is a bad application. While it is bad to submit late in the game, it is far worse to submit a poor or rushed application. Medical schools are unforgiving when it comes to mistakes, typos, or other problems on your AMCAS application. So, if you need an extra week to polish your personal statement, take it.
3. Know thy self (and thy chances!). How strong of an applicant are you? If you have a particularly strong application, you have essentially bought yourself some wiggle room. However, the majority of applicants do not have this luxury — the timing of your submission may actually be the difference between realizing your dream, or searching for another profession.
4. Do your research. Not all schools operate on a rolling basis. Some are semi-rolling. If the majority of the schools you plan to apply to are non-rolling you might be able to invest the extra time to submit a really fantastic application.
5. Don’t forget about the secondaries! It doesn’t matter how soon you get your AMACAS application in if you procrastinate with the secondary applications. Many pre-medical students get overwhelmed by the onslaught of secondary applications that come in and are terribly inefficient at finishing them. When you get to this point, make a prioritized stack of the secondaries (from highest to lowest and rolling to non-rolling) and get to work!

As always, we at Prepera want to hear your thoughts. Feel free to share your stories, insights, wisdom about the application process.

Surely, some will see this as innovative, even revolutionary. I have no doubt that applications to the program will soar. There is no doubt that the MCAT and science classes are the greatest impediment to gaining entry to medical school by the vast majority of students who are not accepted to medical school every year.

The Humanities and Medicine program is innovative, for sure. But innovation is not always good.

In my years of medical school at the University of Pennsylvania, I have not once used organic chemistry, physics, or calculus. However, I am without at doubt a better medical student as a result of taking these courses as an undergraduate. Doing well in these courses required hard work. I had to learn to study effectively and efficiently. Undergraduate physics taught me how to approach complex problems more effectively than any other course that I have taken. When taking organic chemistry, I developed methods that allowed me to memorize large quantities of information. I use both of these skills on a daily basis in medical school.

I recently took both USMLE Step 1 and Step 2, 8 and 9 hour exams, respectively. When studying for these exams, I jumped back to the strategy that I used to study for the MCAT (which was back in the days when the MCAT was 8 hours too). Knowing that this method had worked successfully for me in the past, I had no reason to doubt it as a medical student.

If I had studied the humanities and avoided these difficult undergraduate courses and the MCAT, would my medical school experience have been different? I think so. I took many humanities courses. I enjoyed them and surely gained useful skills from them. But taking more of them, to the exclusion of science courses, would have added very little, at least in terms of medical school preparation.

Prepera readers: Join the discussion. What do you think about changing the requirements for medical school admissions?

Check Prepera.com regularly for future articles about medicine and medical school by Prepera authors.

“So, Tell me about yourself”

What kind of a question is this? What do I say? What don’t I say? Why did they ask me this?! If you feel this way, you are not alone. “Tell me about yourself” was recently deemed the toughest interview question by MSN Careers/Career Builder (unfortunately, their advice was, in my opinion, terribly misguided).
Now, years after my medical school interviews, I understand why interviewers ask this question. In fact, I think in my years of interviewing people both for jobs and for medical school, I have asked every single candidate this question and it is usually the first question that I ask!

Why do I ask this question? The purpose is to get beyond the experience and achievements listed in the resume. I want to know what the candidate thinks is important about him or herself. To me, this much more valuable than the bullet points on a resume.

Why do I think that the MSN/Career Builder advice is misguided? In short, they say that when interviewers asks you to tell them about yourself, this is an opportunity to brag about your achievements and qualifications. If that was what interviewers were looking for when speaking to you, they would ask you directly!

I advise you to get personal. When preparing for this question, think about what is most important to you. Your family? Friends? Religion? Community? Puppy? Career? If so, say it. There will be plenty of time to talk about all of your professional achievements later on during the interview.

How would you approach this tough interview question?

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However, I must admit I was happy to see that the University of Pennsylvania had edged ahead of Johns Hopkins for the #2 spot for the 2011 best medical schools. Harvard Medical School, of course, is untouchable at #1 — with $1.4 billion in NIH research grants, no school can possible surpass Harvard’s overall score, regardless of the actual quality of education or student satisfaction.

So, The University of Pennsylvania edged out Johns Hopkins this year in the medical school rankings. What does this really mean? Nothing, of course. Both remain fantastic medical schools, with excellent faculty and graduates who have access to the best residency programs throughout the country.

The critical question for pre-medical students should not be “what is the best medical school” but rather “what is the best medical school FOR ME?” No matter how much effort U.S. News puts in to their medical school ranking algorithms, they will never be able to answer this question for you.

Thank you for reading the Prepera Blog! Check back regularly for updates and additional advice. And, be sure to subscribe to this blog and follow us on the Facebook to keep receiving free tips!

Since #1 will mainly effect high school students looking for college funding (Pell Grants), we will focus on the effect of #2 on future medical students.

The vast majority of medical students are forced to take out loans in order to pay for tuition and living expenses while in medical school. On average, students graduate with ~$150,000 of debt; it is no longer unheard of for students to graduate with loans totaling between $300-400,000. In the past, the commercial banks that made these loans charged an initial fee of ~1% of the total value of the loan. This may seem insignificant, but over the course of 4 years of medical school, in which the student is borrowing hundreds of thousands of dollars, these fees add up to several thousand dollars.

The most immediate impact of student loan reform on medical students will likely be the elimination of these “administration” fees. Essentially, this will make loans cheaper for students, modestly decreasing the actual costs of attending medical school.

Unfortunately, this does nothing to address the root of the problem — 30 years of tuition increases that have greatly outpaced inflation. Until the costs of medical school are contained, or a significant number of additional loan repayment are introduced, medical students will struggle to pay for school and to pay off loans.