The Underdog’s Guide to Applying to Medical School

The Underdog’s Guide to Applying to Medical School

The information on this website should not be considered medical advice.
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I am a board-certified internal medicine physician and I currently work as a hospitalist on the east coast. I went to Frank H. Netter School of Medicine and then went to North-Shore LIJ for my internal medicine residency. My journey to becoming a physician was filled with obstacles and struggles. I applied to 40 U.S. allopathic medical schools and was interviewed and eventually accepted by only one. I credit my success to my persistence, hard work, and most importantly, surrounding myself with a supportive and nurturing community.

According to the AAMC Applicant Matriculant Data, the total number of U.S. first-time applicants was 46,758 and the total acceptees were 23,711 [1]. This represents an acceptance rate of 50.7% for the 2021 application year. As you can see, getting into a U.S. medical school is a very competitive process and it is crucial that applicants, especially the underdogs, take the right path to get that coveted acceptance letter. In this guide, I hope to share my wisdom as a medical school applicant and interviewer for my allopathic medical school, and help maximize your chances of fulfilling your dream.

Before applying, know your why:

One of the most common and feared questions, both in the application and on the interview trail is, “Why medicine?” The reason that this is the most frequently asked question is that admissions committee members want to ensure that your core beliefs and values align with this noble and respected profession. The journey to becoming a physician is long and arduous, and the committee members want to learn about your motivation as well as gauge whether you are making an informed decision. As an admission interviewer and interview coach, I have heard something along the lines of “I want to help people or serve the underserved” or “I like studying biology.” While these are genuinely valid reasons, they sound generic and vague. My recommendation for this question is to develop a framework that will highlight your drive for pursuing medicine.
The following are some of the things admissions committees look out for:

Another pro-tip for interviews: keep most of the responses open-ended so that the interviewer can ask follow-up questions. Knowing your “why” will also help you with crafting a solid and memorable personal statement.

Prerequisites: Major of study and courses
One of the most common misconceptions is that you need to have a science degree to be considered for medical school. This is far from the truth. In fact, I was a history major with a concentration in European history and minored in Biochemistry. In many ways, my non-science background gave me leverage over those with a biology major and sparked many interesting conversations during my interview. That being said, it is important to consult with your pre-med advisor and ensure that you are taking the prerequisite courses not only to apply to medical school but to also succeed on the MCAT.
The required courses are:
Many medical schools also require statistics (4 credits) and calculus (4 credits), as well as general physiology (4 credits). I would also recommend taking literature or ethics to boost your reasoning skills, especially for the CARS portion of the MCAT. Increasingly, medical schools have expressed interest in students who are well-rounded. It is recommended to pursue your passions and interests outside of science as this will assist with mental health, character development, and your ability to care for others in the future.

According to the AAMC data, the average cumulative GPA for matriculants is 3.74 and their science GPA is 3.67. The average MCAT score for matriculants is around 512 with 128 being the average score in each of the four sections. I would recommend spending an average of at least 200 – 300 hours of preparation for the MCAT. The MCAT can be taken between January to September, but most applicants take it the spring before the admissions cycle.

(Read: How to Study for the MCAT.)

MCAT scores and GPA are only one aspect of the application, and they do not paint a holistic picture of who you are as a person. The AAMC wants to matriculate well-rounded physicians because these individuals have considered all possibilities as it pertains to their career trajectory and are making an informed decision. Additionally, these individuals tend to have better coping mechanisms and can provide better care to their patients. As an admissions committee interviewer, I am often interested in learning about your extracurricular activities because for me, this is a true reflection of your commitment and dedication to medicine. The AMCAS application has a section dedicated to listing up to 15 activities. There are numerous extracurriculars that students can pursue. Some of these include shadowing physicians, studying abroad, research, scribing, leadership roles, etc.

(Read: 5 Ways to Get Into Research Before Medical School.)

Many applicants have questions regarding the number of hours they need in each section. Quality of experience and the way you portray your activity is far more important than the quantity of hours. Medical schools are looking for a long-term commitment to a particular endeavor. Too often, I have seen applicants pursue activities for a couple of months and then switch to another activity. These students are simply trying to complete a “checklist” of activities that they believe will give them a competitive advantage. However, this often backfires because there is no such thing as a standardized checklist. My advice is to pursue activities that will add meaning to your life and will allow having an interesting story. I would recommend that second and third-year undergraduate students start volunteering at a local hospital at least once a week. This will give an early exposure to the field of medicine and help secure letters of recommendation from physicians. I also recommend pursuing a research project to gain exposure to the academic side of medicine. This will help you become an effective clinician and help you do well on the MCAT because it will train your critical thinking and analytical skills.

Researching and picking medical schools:

One of the best tools for researching medical school is called the MSAR (Medical School Admission Requirements). This is an online database that includes a wealth of information about each individual LCME-accredited medical school, with information directly provided by the medical school admission offices. It includes aggregate data that helps applicants gauge their ranking relative to the average matriculant. I personally used the MSAR data, specifically the minimum MCAT or GPA scores, when applying to medical schools. It is recommended not to apply to schools if your MCAT or GPA ate below the 25th percentile in each category. If your scores are low, these metrics can help you narrow your list.

If your scores are above average, I would recommend thoroughly reviewing the individual strengths of the curriculum and the mission statement to determine whether the program will help you reach your potential. I would highly recommend subscribing to this resource toward the end of your third year or several months before you plan to apply. A one-year subscription costs around $30 and is updated on an annual basis.

A common question that I often get asked is whether applicants belonging to an over-represented in medicine (ORM) group should apply to under-represented in medicine (URM) friendly programs? The AAMC designated African Americans, Mexican Americas, Puerto Ricans and Native Americans as URM. If you fall into one of these categories, then I would recommend researching summer enrichment programs that would give you exposure to basic science coursework and clinical medicine prior to starting medical school. If you are ORM, then I would still apply to URM friendly schools only if you fit their mission, and I would focus on writing a compelling personal statement.

It is important to apply broadly, and it is a mistake even for top-scoring applicants to apply to less than 20–30 schools. If your GPA and MCAT are not competitive, it is beneficial to save up money and apply to upwards of 40-50 schools. One of the things that helped me with this process was making an Excel spreadsheet to keep track of average GPA and MCAT scores. In addition, I had a section where I wrote down the unique aspects of the curriculum and incorporated interview-related tips from Student Doctor Network. (Check out our article on med school application financing here.)

One other key aspect of picking medical schools involves deciding between private versus public schools. Public schools tend to have lower tuition costs than private schools, but they might not have the same prestige or research opportunities. Additionally, public schools may have residency restrictions for those applying from out of state (OOS). These schools may only accept a certain number of individuals from other states, putting OOS applicants at a great disadvantage. It is important to evaluate in vs. out of state acceptance data before deciding to apply to a public school such as the University of Washington, Mercer, or San Juan Bautista.
Application Timeline:

The most important key to remember is that medical school admission is on a rolling basis. The best way to optimize your chances of getting accepted, especially if you are an underdog, is by submitting your application early. I advise my clients to start meeting with their pre-health advisor toward the end of their second year. In January of their third year, I would start requesting letters of recommendation (LOR) and give the writers at least 6-8 weeks to write a compelling letter.


Most medical schools require two letters from science professors who taught you, and prefer to see letters from employers, supervisors, mentors, and other individuals who know you well. Additionally, when the applications open for editing, applicants should follow the specific instructions to send their transcripts to the application services; this can take upwards of a month, so it is important to do this as soon as possible.

The AMCAS application usually opens in early May and can be submitted at the end of the month. The cost of the initial AMCAS application is $170 and $43 for each additional school. After submitting, the application goes through a verification process which can take upwards of 1-2 months. Once verified, the earliest that an application can be transmitted to schools is usually in late June. If you submit early, it is likely your application will be verified early as well meaning that your application could be in the first batch reviewed by a school. A completed AMCAS application consists of a personal statement, transcripts, list of extracurricular activities, LORs and demographic information. It is important to note that you will not be able to edit your primary AMCAS application once submitted, but you will be allowed to add more schools after submission.
TMDSAS is a centralized application service for applicants who are applying to medical, dental, or veterinary schools in Texas. The TMDSAS has a flat application fee of $200 regardless of the number of schools applied to. TMDSAS application opens on May 3rd and the submission opens up on May 17th. The submission deadline is November 1st, but I would strongly urge applying sooner because medical schools start sending offers of acceptance as early as October 15th.
AACOMAS is a centralized online application service for U.S. osteopathic medical schools. The cost of the AACOMAS application is $195 plus $45 for every application after the first one. The application typically opens the first week of May and medical schools start receiving applications mid-June.
The next part of the application process is submitting secondary applications. These are school-specific questions sent to applicants via email from each medical school they apply to. Each essay can range from 100-2,000 words, and most schools have an application fee of $75-150. The secondary application process can start as early as July, though it is recommended that you begin to “pre-write” your secondary essays as early as the spring you apply. Applicants can find the school-specific secondary essay questions from the previous year on Student Doctor Network. Again, it is recommended that applicants return their secondaries as soon as possible; we suggest no later than 2 weeks after invitation. To ensure that you are able to keep track of where you are at with your applications, we recommend using a spreadsheet. Marking when you received and sent your secondaries will ensure that you do not make mistakes or forget a deadline.
Casper and SJT:
Some schools require one of two ethics-based tests: Casper and the Situational Judgment Test (SJT). Both exams test your ability to reason and apply professional logic to real-life situations. These tests are usually taken in June or July of the application cycle.

Typically, medical schools will start extending interview invites toward the end of July or early August. In general, medical schools will interview the majority of the candidates between September and January. Applicants should begin preparing for interviews as soon as possible, including obtaining a suit, access to an appropriate computer and environment for virtual interviews, and practicing interview questions.

The first date that MD schools can begin sending acceptances is October 15th. Most AMCAS schools then continue accepting students on a rolling basis. Others, like Harvard, send out all of their acceptances in the Spring. DO schools begin sending acceptances in August, and TMDSAS schools participate in a match process. I would recommend filling out your FAFSA once you start getting interview invites. You can always update the schools even after the FAFSA is submitted. Most medical schools will typically start in August and some might have summer enrichment programs to ease the transition from undergraduate to graduate school.
Interview and post-interview dos and don’ts:

Finally, your hard work is starting to pay off. I remember feeling thrilled when I got my first interview invite. You should definitely take the time to celebrate this milestone. Now, you might be wondering how to prepare for a medical school interview.

The first thing I would recommend is going on to Student Doctor Network (SDN) and checking out the school-specific threads. One great thing about being a part of a community is that you can learn from others who were in your shoes not too long ago. There are post-interview threads that detail experiences including questions that were asked; reviewing these will help you feel mentally prepared for the interview day. I would also recommend thoroughly reviewing your application, especially your extracurriculars and personal statement. The key will be to be able to link these different experiences into a cohesive narrative that would clarify “Why medicine?” I would recommend doing mock interviews with your undergraduate faculty members or pre-health advisor. They don’t necessarily need to be science faculty members. I would give them a bunch of questions that you found from SDN school-specific thread.

There are different formats of the medical school interviews ranging from traditional interviews to group interviews to multiple mini-interviews. The traditional interview is a one-on-one interview with a faculty member that generally lasts for 30-45 minutes. Traditional interviews can be either open or closed: open means that the interviewer has access to your file whereas closed means they learn about you only from your answers.

Another format is group interviews. In a group interview, there are more than 2-5 candidates who will be interviewed by 1-3 faculty members. Usually, these interviews are focused on presenting your team with scenarios and they assess your ability to collaborate in a group.

The last format is MMI, which involves 5-10 different stations with a specific question or a scenario. The MMI is a closed interview format, where your interviewer has not reviewed your application. In my opinion, this is the best format because it allows the interviewer to objectively assess your nonverbal communication skills, moral compass, analytical skills, and ability to think on your feet.

Preparation and familiarity with the interview format are key to acing your interview. I would also recommend writing a thank you note to the interviewer within 48 hours of your interview unless the medical school instructs otherwise. I would also recommend not writing a Letter of Intent post-interview until you receive their decision.

Once your interview is complete, a school will usually send you a decision within 4-6 weeks. Most schools will call or email with an acceptance, rejection, or waitlist. Waitlist movement is slow at first and school-dependent. In April, those carrying multiple acceptances must narrow their selection to one school choice. At this time, waitlist movement begins to pick up into early and mid-May. Do not lose hope if you are on multiple waitlists: it is possible to be accepted up until the first day of classes.

If you are not accepted, it is best to take time off and work on your application rather than immediately re-applying. Many medical schools offer feedback to those that are rejected, especially if the rejection is post-interview. Talk to your mentors and advisors about your application and follow the advice given to you before starting another application cycle.

Finding your “perfect fit”
My hope for everyone reading this guide is that you have been accepted into your dream school. If you are one of the lucky ones to have multiple acceptances, then I would consider choosing the one that is a “perfect fit.” I would consider picking a school that is affiliated with a university hospital, offers a good financial aid package, and has a unique curriculum that aligns with your life goals. The mission statement of the school is a good reflection of the type of physician you will become and is something to consider when making the final decision. For instance, I was always interested in global public health. I was fortunate to have the ability to attend seminars on healthcare disparities and this opportunity enriched my medical education.

I hope this guide helps you achieve your dream acceptance letter. If you would like to connect, you can email me at [email protected] or check out my website to schedule a complimentary 15-minute session to discuss ways I can help you get to the next level.

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