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68 medical schools. That's the record number (for us at Passport Admissions, at least) of schools that one of our students applied to. If you had to guess, do you think that student got in?

Of course not. Anyone applying to 68 medical schools is almost certainly going to have the following characteristics:

1. Their numbers are iffy (GPA below a 3.5, say, or an MCAT lower than 510)
2. They desperately hope to get into MD school (instead of taking the time to evaluate DO schools or international schools)
3. They don't want to wait an extra year to improve their application

Talk to pre-meds doing this, and they will usually rationalize the approach: "Well, I'm going to apply to see what happens." Or "I want to aim high. Shoot for the moon, end up among the stars."

It's called the Shotgun Approach: fire enough pellets at the target and one is bound to stick, right?

Wrong. Call me cynical, but I can often see these rejections coming. And of course, given the odds of getting into medical school with low numbers, it's an easy bet to make.

CAN YOU GET INTO MD SCHOOL WITH LOW NUMBERS?

Yes. If you’re a student that the medical school wants for some reason. Medical schools want students they don’t get enough of: the kids of big donors of the school, underrepresented minorities, students with outstanding leadership qualities.

Let's say your numbers look like this:

• 3.8 GPA
• 502 MCAT
• Ethnicity: Asian
• Your extracurriculars are strong, but you haven't cured cancer or done anything to stand out and make you leap off the page. What are your chances of getting in?

According to the AAMC's chart, you have somewhere between a 16.6% and 26.1% shot of getting in. Let's split the difference and call it 20%.

That's not nothing, but that's not likely, either. It's about half the acceptance rate (42% or so) for the rest of the applicant pool.

And look, I get where these pre-meds are coming from. Retaking the MCAT is not fun. Plus, they’re genuinely good people: they've worked hard in their classes and spent a ton of time helping their community. Trying to tell these pre-meds not to apply is almost like telling them they don't deserve to be a doctor. Plus, when I try to convince them that their chances are low, they squint really hard at the 20% and say, "See? Others have done it!"

That 20% includes students who are the first in their families to attend college (who get bonus points from medical schools), students who are the sons and daughters of admissions committee members, and students who are from states like South Dakota, which has a medical school that will give anyone with a pulse an interview. In other words, if these three qualities (disadvantaged, well-connected, or in-state preference) don't apply to you, then your chances are even lower.

But I'm not going to try to convince you that you won't get in. Anything is possible, and we don't know what your outcome will be. Instead, I'd like to show you the potential costs so that you can make the decision for yourself.

THE PROS AND CONS OF THE SHOTGUN APPROACH OF APPLYING TO MEDICAL SCHOOL

Let's evaluate the pros and cons of the Shotgun Approach, especially the "I'm only applying to MD schools this cycle" shotgun. Let's assume you're not crazy enough to apply to 68 schools, but you may be thinking about 40 (I hear this number a lot from people trying this approach).

THE PROS AND CONS:

PROS

• A 20% shot of getting into an MD school

CONS

• You will probably return your secondary essays slowly, if you return them at all
• You probably will waste $4,000+ to apply
• You probably will delay your medical career by one year, which costs you $250,000 in lost salary
• You may hurt your chances of ever getting in

DISCUSSION OF ASSUMPTIONS IN THE CHART

• You will probably return your secondary essays slowly: This is the main reason the Shotgun Approach fails. Many pre-meds send their primary application to 40 schools, but they only return secondaries for about 20 schools. Or even worse, they get overwhelmed and return their secondary essays slowly.
• How does that all work? After you send in your primary application, most med schools will send you a secondary automatically. This means by early July (assuming you apply the first week of June), your inbox will be overflowing with secondary essays. Which will you return quickly and which ones slowly? Many pre-meds focus on the highest ranked schools, neglecting the schools where they actually have the best shot of getting in. Oh, and one more thing: med schools are timing you, so if you respond slowly (more than two weeks), then your chances of getting an interview at that school plummet.
• You probably will waste $4,000+ to apply - Since you probably won't get in, you will get little return from your application fees. Application fees for 2018 are $160 for the first school and $37 for each additional school. That's $1603 just for primaries. Add in the cost of ~35 secondaries (depending on the schools you choose, you probably won't get secondaries from all 40) at an average of $80 each and you'll pay another $2800. That's already $4,400 before the costs of flying to any interviews.
• You probably will delay your medical career by one year, which costs you $250,000 in lost salary - Since you probably won't get in, you push off your doctor's salary by a year. Let's assume that the average pre-med earns about $40,000 a year in salary at whatever entry level position they can get. That's about right for scribes or lab assistants or other jobs that pre-meds hold during a gap year. According to MedScape, the average physician salary is $294,000. Specialists earn more ($316,000), primary care less ($217,000). By delaying your medical career by a year, you lose roughly $250,000 by continuing to make so much less while you wait. That's a little simplistic, but even if you lose half that, that's still six figures you're losing for the chance at MD school.
• You may hurt your chances of ever getting in - there's an argument that cuts both ways for re-applicants. On the one hand, they're usually more mature and stronger students since they have already made mistakes in the application process. On the other hand, when you re-apply, the schools compare your old application to your new application to see why they rejected you last time. They assume that there's something wrong with your application and then see if you fixed it. In the specific case of applying with a low MCAT, the easy solution is to retake and get a higher score, but that's a big if.

There's an EASY ALTERNATIVE that combines all of the pros above with none of the cons: apply to DO schools simultaneously.

If you combine a more limited version of the Shotgun Approach (say, 20 MD schools) along with a solid 15 DO schools, you get the following list:

PROS

• A 20% shot of getting into MD school*
• A 50% shot of getting into DO school
• A 60% shot of getting in somewhere
• You pay ~$400 less in application fees
• You probably won't waste application fees
• You probably won't delay your medical career

CONS

• You will need to take the time to learn about osteopathic schools, including the time to shadow a DO (and hopefully get a letter of recommendation)

DISCUSSION OF ASSUMPTIONS IN THE CHART

• The difference between applying to 20 and 40 "reach" schools is negligible. Adding more reach MD schools is like buying more lottery tickets: your odds are greater, but it's not significantly increasing your shot. For one, you're unlikely to return the secondaries to all of those schools anyway (the biggest mistake most pre-meds make). Two, you're still applying to the 20 that are most likely to accept you, (where your MCAT is in their "acceptable" range). Three, for schools where you don't have any ties or connections or even preferences, it's harder to make the case for why you are a good fit for their program. Pretend that you're going to have to answer "why our school" in either the secondary or (knock on wood) the interview. If you aren't a natural fit, it's going to make the road of getting in harder. In other words, those extra 20 MD schools aren't the places that are likely to see you as a fit anyway.

Unfortunately, AACOM does not produce a chart that can help predict your chances. But a 501 MCAT is about average for the overall application pool (501.1, 502.3 for Asian applicants) and close for matriculants (503.1, 504.4 for Asian matriculants). The GPA is quite strong (3.45 applicants, 3.53 matriculants). Being conservative about your chances, I'd predict your shot of getting into DO school is about 50%.

Doing the math, the chance that you get in somewhere (either MD or DO school) would be 60% (since the chance of getting rejected at both MD and DO schools is 40%).

The only con is you have to spend some time to learn about DO schools. But a few hours of shadowing is a small price to pay for the vast benefits of using this approach.

BUT WHAT IF I DON’T WANT TO BE A DO?

Think hard about why. Is it a good reason, or is it just an ego thing?

DO residency results are really similar to low-ranked MD schools.  Most patients don’t know the difference between MD and DO schools. Being a DO is likely a great way for you to achieve your goals.

The reasons most pre-meds don’t want to be a DO usually boil down to:

1. I haven’t investigated it yet.
2. A friend of a friend said that I shouldn’t be a DO.
3. I’ve always dreamed in my head that I would get into MD school, and I don’t want to let the dream go.

Those aren’t particularly good reasons in the grand scheme of life. There are good reasons to prefer MD: MD schools have more research opportunities (if you’re into that kind of thing for your career), and MDs are universally recognized abroad (DOs only have full practice rights in about a third of the world’s countries).

Or put it this way: why would you let your ego cost you six figures?

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