AACOM Survey Reveals Characteristics, Preferences and Decision-Making of Medical School Applicants

By Laura Trude, HWIC Information Specialist

Jill Meron, Associate Director of Research, and Thomas Levitan, MEd, VP for Research and Application Services, American Association of Colleges of Osteopathic Medicine (AACOM), recently published a report on a survey of medical school applicants entitled, 2009 Applicants to COCA-Accredited Osteopathic and LCME-Accredited Allopathic Medical Schools. The report covers a number of interesting issues, such as when students decided to pursue medicine, why they chose to attend a particular medical school, and their average MCAT scores and GPAs.

One interesting finding was when students decided to study medicine: half had decided before the end of high school and about a quarter had decided even before they entered high school.

“That was something we just didn’t know, that so many of them would decide at such a young age (before high school) that they wanted to go to medical school,” notes Meron.

Levitan adds, “I think all along, I had this gut feeling that there are only a few professions people decide on when they are five years old: to become a doctor, to become a veterinarian. I don’t think people decide they want to be an engineer when they are five years old. In some ways, it’s reflected in medical school applications: there are people who don’t get in and they try again, and again, and sometimes again, and again. I don’t think people who go to architecture school do that.”

The number of students who reapply to medical school demonstrates their strong commitment to becoming physicians. “We’ve got 74% who are going to be reapplying for osteopathic medical school; that’s a very large number,” Meron points out.

Osteopathic medical schools are known for their holistic focus. While 42.3% of osteopathic medical school matriculants chose osteopathic medical school because of the osteopathic philosophy and/or preference for a DO degree, many survey applicants reported that they would prefer to have an allopathic medical degree.

“Historically,” explains Levitan, “depending on where someone grew up and what their background is, having a DO degree may seem less prestigious. When people think of becoming a doctor, they generally think of MDs. We need to better and more broadly explain what a DO is and how a DO behaves similarly to and differently from an MD as early as possible so prospective applicants understand that DOs are doctors; they just have a different philosophy than MDs. And maybe the osteopathic approach to medicine is one that will resonate with them, with their approach to life.”

The preference for an allopathic degree is reflected in the survey results. 70% of survey respondents also applied to a U.S. allopathic school. Of the 26% who were admitted to both an osteopathic and allopathic school, 89% enrolled in an allopathic medical school. The average MCAT score and GPA for those accepted into allopathic medical schools were also slightly higher: 28.9 and 3.56 respectively, as compared to 27.3 and 3.5 for osteopathic applicants offered admission.

While allopathic and osteopathic medical schools have increased their total enrollment since 2002, increased enrollment has not hurt the quality of medical school applicants in terms of quantitative measures such as test scores and GPA due to the fact that “both the applicant numbers and matriculant numbers are continuing to edge up,” notes Levitan.

He cautions, however, that quantitative measures alone do not define a quality medical student: “In fact, we know that if you hit a certain level on the MCAT, a good education will make you a good doctor. So you don’t necessarily need a 29.”

AACOM is pursuing outreach activities to help people understand the differences in osteopathic and allopathic medicine earlier.

Levitan highlights one example: “We hosted our first health professions recruitment fair last month in association with the AACOM annual meeting of osteopathic medical school deans, other administrators, faculty members, and students. We targeted high school students in the DC area; we didn’t just reach out to undergraduate college students. We had good participation by high school students, high school counselors, and parents.” More than 200 people attended the event.

Recruiting more underrepresented minority students, women, and students with lower socioeconomic status is another issue that needs to be addressed. Levitan explains that “the health care provider population should look like the population it serves, and it doesn’t right now” in terms of race, ethnicity, and economic class. ACCOMAS Applicant Pool Profile provides more information on the diversity of applicants. “On a positive note,” he adds, “we’ve gotten close to the medical population we treat in terms of gender.”

Ohio University and Oklahoma State University both have programs that seek to recruit underrepresented minorities into their osteopathic medical schools, as do other osteopathic medical schools and allopathic medical schools.

“OUCOM hosts a premed program that is fully funded,” states Levitan. “If the admissions officers say, ‘We think you’re going to be a good doctor, but you need a little more background in the sciences,’ they basically pay you for that year of science education. OSU has a very similar program.” Medical school applicants are also wealthier. Levitan, recalling a conversation with a faculty member, mentions that: “He looks around his classroom and is seeing more students who have to take fewer loans or who have the ability to pay more.” Levitan surmises how this trend is impacting the diversity of the medical applicant pool, “We’ve always known that first generation college students, underrepresented minority college students have a fear of taking on that kind of debt. It’s just not something that you’ve thought about and your family has thought about.” Despite this, students continue to take on debt. AACOM reports an average debt load of $179,963 per survey respondent from 2009 osteopathic medical school graduates. AAMC reports an average medical school debt of $160,000 for the same year. Medical school tuition increased about 4% for osteopathic medical schools and 5% for allopathic medical schools in the past year.

Levitan offers a few ideas to keep down medical school costs and debt load: “We clearly need to increase financial aid, and schools must do their best to contain costs and tuition. We heard this morning [at the AAMC Physician Workforce Conference]: provide more service-based debt relief, more service-based scholarships, and loan repayment programs to make it possible for people to go to medical school and get their loans repaid.” In fact, the health care reform legislation is allocating $1.5 billion dollars over five years for the National Health Service Corps to provide service-based debt relief to encourage more physicians to go into primary care and work in areas experiencing physician shortages.

The cost of medical school also affects which school students choose to attend. For survey respondents who chose to attend a particular allopathic medical school, cost was the second highest factor behind geographic location. Levitan speculates that even the importance of geographic location for allopathic students relates to the cost of medical schools: “75% of the MD schools are public; 25% of the DO schools are public. Every state has a medical school for which its residents can pay in-state tuition, even the states that don’t have a medical school. Alaska doesn’t have a medical school, but its residents can go to Washington and pay in-state tuition. So certainly on the MD side I would expect geography would be a factor because students would want to get in-state tuition.”

Students who choose allopathic schools were more likely to consider degree preference and specialty opportunities in their choice of school, although the college’s approach to learning and reputation were ranked highly by both osteopathic and allopathic matriculants. Geographic location was also the top reason students choose to attend a specific osteopathic school.

As Meron notes, “It was interesting to see that was the number one finding, regardless of whether one went to an osteopathic school or an allopathic school. People want to be where they want to be; geographic location is the major determinant.” Indeed, previous studies have found that where students attend medical school and particularly where they complete their residencies strongly influences where they end up practicing.

The number two consideration for students in choosing a medical school was the school’s approach to learning. Levitan considers this finding encouraging: “Because I oversee the application service, I continually respond to applicants questioning which school has the highest placement rate into a particular residency program. But that’s not why people should choose a medical school. People should make their decisions because of the way they want to learn, and because of the teaching they will receive. 95 to 96 percent of medical students graduate, no matter where they go to school. So it’s not whether you get out, it’s whether you’ve learned the way you want to learn.”

Meron is already preparing to send out the next applicant survey. There are some issues AACOM would like to explore further.

“The one group we are curious about,” states Levitan, “is the group of students who were accepted by both osteopathic and MD medical schools but chose not to go to any medical school. What’s going on there? Probably financial or family issues,” he surmises.

While this survey focuses on osteopathic medical school applicants, other studies consider all medical school applicants. A couple of years after receiving applications, AACOM and AAMC share the names of their applicant pool with each other to synthesize the data from osteopathic and allopathic applicants. Three Pathways to a Physician Career: Applicants to U.S. MD and DO Schools and U.S. Citizen Applicants to International Medical Schools examines the overlap among osteopathic, allopathic, and offshore medical school applicants. Currently, there are not a lot of data on offshore medical schools. Meron and Levitan will try to gather more information on this applicant group through their next survey.

For more information on medical school applicants and related issues, more than 300 resources from various organizations and journals are available through the Health Workforce Information Center under Physicians: Education and Training. Resources can also be narrowed by location and topics such as Student Debt and Specialty Choice.