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Combined BA/MD Program: My Take

June 9, 2019

Aspiring doctors, this one’s for you. 

If you are pretty sure you want to become a physician, there are different ways to get there.

The traditional route involves completing a 4 year undergrad degree, a 4 year medical degree, 3-6 years of internship and residency, and sometimes, an optional round of training called fellowship, for 1-3 years.

In my day, a person wanting to practice interventional radiology (this is changing a bit) went through eight years of post-high school education, followed by six years of internship, residency, and fellowship. That’s a post-college commitment of 10 years, or 14 years beyond high school.

Because I did a combined BA/MD program at Rutgers, the State University of New Jersey, I was able to shave one year off that 14 year pathway. My first year of medical school was split into two, and overlaid on my final two years of college. This allowed some courses to count toward both degrees.

There are different kinds of combined and accelerated BA/MD programs, and I can only speak to my experience and my program. However, I suspect many points will apply to other similar programs. These programs are of incredible value for the right candidate.

As we say during the informed consent process for procedures, surgeries, or medications, you should have an idea of the risks, benefits, and alternatives of the procedure before forging ahead. Here is my risk/ benefit profile for those considering a combined degree, compared to the traditional pathway.

Benefits:

Time:

If you know where you want to go, why not take the most direct route there? If you know you want to be a doctor, combined BA/MD programs provide a straight shot to get there. Some credits from medical school can count toward your undergrad degree, a biological sciences degree in my case. So for example, rather than taking a college level biochemistry course, I took the first year medical school biochem course. Because of the double counting of credit, there is potentially more time for other courses. With time for more electives, I added a Spanish Language & Literature Minor. As a bonus, my medical school held evening courses in medical Spanish, allowing me to synergize my learning.   

I got to be a younger doctor.

I’ve been grateful for this time and again. I was able to establish myself in my attending job for a few years before child-bearing, because I was not under any time pressure. An attending by 31, my husband and I had time to travel to Southeast Asia before getting pregnant. Contrast my experience with that of a close friend, who trained in surgery through her mid thirties. She had her first child in residency, and is expecting a second just before she starts her first attending job. I feel fortunate to have had the time to build my reputation, prior to going on pregnancy-related bed rest, and taking maternity leave.

Being a younger doctor means you may have more years to practice your craft, and ascend and evolve through your career. You can enjoy a longer career, helping more people, or, you could serve an average amount of time, and pivot to another career later in life. Medicine does not have to be the last stop for me.

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Financial:

I saved a full year of tuition by taking first year medical school classes while enrolled in college. Upon college graduation, if we maintained certain standards, we became officially matriculated at Robert Wood Johnson Medical School as second year students.

As a result, everyone in my program saved one year of living expenses as a student. 

We did not have to take the Medical College Admission Test, the MCAT, and therefore we did not have to pay for it. (Don’t worry, there will be plenty of licensing exams to pay for later!) Since we didn’t take it, we were not required to buy expensive MCAT study materials or tutoring. 

Applying to just one program, we did not pay multiple application fees to various medical schools. 

Finally, because my final educational debt burden was lower than it could have been, my associated interest payments were lower. Every small win counts!

Emotional/ psychological:

Knowing you are accepted to a medical school early is a huge mental load lifted off the undergraduate years. Many students will spend not just the time and money delineated above, but a large amount of mental bandwidth, to maneuver in every way possible, and to optimize their admissions application. For some, every decision as an undergrad is made with medical school in mind. Being taken out of this “race” allows you to simply focus on what you are doing, whether the undergraduate Parasitology class you’re engrossed in, the slam poetry you’re experimenting with, or the medical school courses you’re privileged to attend, from anatomy lab, to microbiology, pathophysiology, pharmacology, statistics, ethics in medicine, and more.

Support

You get the support of the peers in the program as you move from one medical school class to the next; in our year, there were 14 BA/MDs. We also became familiar with and developed a kinship with the BA/MDs ahead and behind us.

Because those in our program started med school with one class and finished the first year with the next class, we were able to meet and work with students that would become our immediate upperclassmen. Some of those friendships lasted throughout medical school. Sometimes these upperclassmen were able to clue us in on what was to come, before we went through it ourselves. The could tell us what the curriculum they were facing was like, and how we could prepare. As we entered the clinical years, years 3 and 4 of medical school, they could give us insight into what to expect on each rotation, and how to excel.

Risks:

Fear of missing out (FOMO):

Effectively or mentally leaving college early, you trade sleepless nights partying for sleepless nights studying and learning to take care of patients. 

There is decreased time to bond with dedicated college friends, with an earlier transition to medical friends. 

There’s no built-in down time with a combined program; if you want to take a year to reflect, or go into the Peace Corps, an accelerated program may not be for you. My combined program touted taking students out of the rat race of med school admissions, to allow us to diversify our interests. Most BA/MDs completed the program in seven years, but the program allowed us to take eight years if we wanted. They wanted us to use the extra time to pursue research or other interests, with the focus on hosting “well rounded” med students, not just those singularly focused on medicine. I think this is a healthy philosophy, and I was happy to benefit from it.

Shorter school breaks.

As you might imagine, holiday and summer breaks are shorter in medical school, and they can be co-opted by research and shadowing opportunities if you so choose. I opted to travel instead. For me, travel allowed me an opportunity to reset from the grind of studying. It was a tough decision, allowing my classmates to get ahead while I played, but I knew I needed periodic breaks, and ultimately, this was the right decision for me.

Fewer potential schools to choose from

Since a fraction of medical schools around the nation offer combined programs, there are fewer schools to choose from. Some programs begin directly from high school, while others, like mine, are offered to applicants their sophomore year of college.

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Competition

Combined BA/MD programs are competitive. But if you don’t make it in on the first try, you can still apply according to the traditional route.  

Don’t be surprised if you feel less mature or sophisticated compared to your classmates. The application for our combined program described the ideal candidate as more mature than average, but when chosen, I still felt the maturity gap with my peers. This is not all bad, as it turns out. How do you become more mature? By hanging out with people more mature than you. By learning to take care of people’s medical problems while respecting their humanity. It’s a lifelong learning curve, really.

Because I was less mature, there was some need to compensate for lack of ‘real world’ experience. For example, when my interview skills fell short during a mock residency interview, I needed remedial interview help.

Envy

There is the potential for inciting envious feelings from peers that took the longer, more costly path. For this reason, I didn’t need to mention skipping the MCAT to anyone around me. It was a fresh wound for those who’d endured the months, or sometimes years of associated study, fees, and pain. On the other hand, I knew some students had full tuition scholarships, or were funded by family, making their paths easier in a way. In the end, everyone’s path is different.

Perception

Some think that a high school or college student is too young to make such a commitment to a prolonged training path like medicine, but this is very individual dependent. For those who are unsure about the career choice, a combined or accelerated program may not be best. But if you are called to medicine and can’t imagine doing much else, I say trust that feeling. Some cite an increased rate of attrition among early entry applicants, but that can happen to anyone in the medical pathway. I announced I’d be a surgeon by age 3, and was volunteering in the ER by high school. I was pretty sure this was the path. 

You’ll be told you look young.

This can happen regardless of your looks, given the decades between you and the people you’re generally caring for during training. There is ageism in medicine, and some of it is accepted, since more age often equates to more experience. In the end, your level of competence matters most, and training is difficult, regardless of whether you’re already sporting gray hairs or not.

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Alternatives:

Do it the traditional way. It’s the most common way to become a doctor!

Learn what you’re interested in, if that can lead to a viable career when you’re finished. My first boyfriend was a nursing student, and worked as an RN for years before going back to medical school. 

Blaze your own path.

Medicine is a prescribed pathway, not for those who are used to trailblazing. If you want to do both, that’s cool too.

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