David Altshuler, M.S.
(305) 978-8917 | [email protected]
There’s always hope.
Nah. Not really. Not always.

At a recent meeting of pre-meds at a university whose name you would recognize, the panel of actual medical students and genuine doctors gave advice to the aspiring (“slathering” has such unfortunate connotations) physicians. Phrases were bandied about like Frisbees at a windy rock concert: “minimum of one thousand hours of community service;” “if someone on the admissions committee takes you to lunch, be nice to the waiter;” “genuine research;” “third author, published paper, juried journal.”

All of this advice is true. Accepted candidates to medical school likely have tons of hours of community service and research and have their names on published articles in legitimate journals and are nice to waiters. Here is more true advice: when a woman goes into labor, a rum life saver will help with the pain of childbirth.

But the cold fact is that an epidural–remember Joan Rivers who said that “natural childbirth” means “no makeup in the delivery room?”–is MORE helpful for the excruciating agony of bringing another little person into the world. A rum lifesaver, while lovely I’m told, adds very little to the efficacy of a needle in the spine.

All that advice about what to wear, how to look your interviewer in the eye, and the firm handshake makes a difference IF AND ONLY IF the doctor wannabees got an A in organic chemistry. Both semesters. If FDS (Future Doctor Susie) didn’t get an A in organic chemistry then she can have three thousand hours of community service, enough published papers to start a small library, and the firmest handshake this side of an eager politician and it won’t matter to the admissions committee. She still won’t be admitted to medical school. In less enlightened times, someone might mention that it wouldn’t even matter just how nice FDS was to the waiter after the interview.

Of a roomful of first year college pre-meds, only 10% end up applying to medical school. Of those, about 40% are admitted to a medical school in this country. That means that only four out of a hundred pre-meds get into medical school. You’ve heard the saying, “Organic chemistry makes more history majors than it does doctors”? It’s true. The first year pre-meds who didn’t get an A in organic chemistry don’t get admitted to medical school. There’s always hope? Yes, there is always the hope that they will get on with their lives and be happy doing something other than practicing medicine.

If you are a five-foot, four-inch tall male, your odds of making it to the NBA are one in a bunch. There has been one NBA player under 5′ 5″ tall. I’m sorry to be the one to tell you this, but you are not he. You can practice for 10,000 hours; you can learn how to dribble with your left hand; you can learn the names of all the mascots of all the NBA franchises but you will never get on the court during a game unless you have a mop in your hands or are being followed closely by arena security.

We do our children a terrible disservice when we tell them that they can do anything they set their minds to. We harm our kids when we say that they can accomplish anything. The ugly truth is that not everyone can go to medical school or play in the NBA.

Which is not to say your shouldn’t encourage your kids. Which is not to say they shouldn’t give it their best shot. But “if at first you don’t succeed, try, try again” isn’t true for skydiving. And it isn’t true for raising kids who have a shot at coming to understand that they are okay as they are either.

Maybe there is always hope. There is hope that we will love our kids for who they are, whether or not they are accepted to medical school.
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7 thoughts on “Hope

  1. James Montgomery

    As one of those 3.34 students who would not make it into medical school in the last couple of decades, I lament that Organic Chemistry (one semester B and one semester A – confuse the admission committee?) makes such a huge difference. After taking the first test with the flu and making a C, I was told by the professor that I could forget medical school without an A in his class. I was accepted 2 weeks later and left his class with an intentional, though not deliberate C. I am reminded of the PGY4 that I worked with as an intern who, during a code described the chemical composition of epinephrine and what receptors it would affect in the fibrillating cardiac muscle, along with other intellectual concepts of intracardiac epinephrine during a code until I leaned in and said, “Give him the damned epinephrine!” His intellect overrode absolute common sense. I have seen this far too many times as a psychiatrist, hearing about the abysmal bedside manner of physicians. Most patients will acknowledge that their physician is “brilliant,” but go on to wish for a personality and a bedside manner. What contribution does the GPA make to empathy, compassion and emotional intelligence? Oh, that we could measure that in twenty-something “Premeds” with partially formed prefrontal cortices! Please hear my call for balance!

    1. David Post author

      Excellent, articulate points, Doctor.

      Glad you wrote. Thank you for reading. Honored to have you with us.

      “What contribution does the GPA make to empathy, compassion and emotional intelligence?” Well said. And here’s something else I’d like to measure: what about psychopathology? What about a preponderance for alcoholism and drug abuse? Can we screen for doctors who are more likely to give back to under-represented communities?

      I know there is a slippery slope here. I know “predictions” of all kinds have been used to discriminate in the past. I wish I knew how to pick out future doctors with ethics and sense. You are certainly correct: an A in calculus doesn’t help that smart kid “give him the damned epinephrine.” 🙂

  2. Matt Erickson

    David, You just hit on a lot of topics I find interesting. I have never bought into the “you can do anything” approach to parenting or mentoring. Sadly, my boys who love basketball, have been informed by their mean father that the NBA is most likely not in the cards for them despite their solid athletic abilities. Steering our kids towards realistic expectations is definitely the way to go. With the right approach and relationship, this can be done without crushing their dreams or demoralizing them.

    I’ve seen way too many kids who were fed this line while having very few actual expectations or demands made on them. This creates an entitled teenager who gets blown over by a stiff wind. It’s fun to be a part of an industry where we can help kids build some character and resilience.

    Take care David and keep running! Personally, I walk.

  3. Robert T McGrath

    Perhaps a bit darker and more edgy than previous posts, but the truth can be both dark and edgy. I guess there’s always a reason for hope and optimism as long as they don’t lead to self-delusion. Many things have been accomplished against long odds but statistically there is a good reason for those odds.

  4. Phil

    This speaks to the deeper question about the lie that is the American Dream, or any related myth about the perfect correlation between hard work and success. Of course most successful people worked hard, and they’re the ones we hear from. But a lot of unsuccessful people worked hard too. It’s a shame a lot of people believe in this myth, and it’s hard to dispel, but your blog has helped me do that and see clearly for the first time.

  5. George

    I couldn’t have played in the NBA no matter how hard I worked (the operative myth in this particular case is Michael Jordan, who supposedly worked hard after being cut from the high school basketball team. In reality, the coach, recognizing his potential, asked MJ as a freshman to play a few games on JV rather than come off the bench for varsity in order to improve as much as possible. MJ refused and rejoined his sophomore year, after a summer in which he grew six inches. Again, he also worked hard, but luck matters and myths of hard work being the sole factor in success are damaging).

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