Making the Cut: The Real Pre-med Requirements

Students file one-by-one into the green seats of Science Center B’s lecture hall. They sit down, pulling out laptops or legal pads, sometimes problem sets to complete in class. A constant hum of gum chewing, chair-shifting, and text notifications is amplified against the walls.

The room has yet to quiet down when Life Sciences 1a, Harvard’s 448-person introduction to chemistry, molecular biology and cell biology, begins with an unwelcome announcement.

There will be a “little quiz” in section. Students in the packed lecture hall respond to the news with a loud groan.

“Don’t you want to know how things are going?” molecular and cellular biology professor Robert A. Lue calls back. The class responds with a resounding “No!”

Lue reasons, “It’s important to diagnose how everyone’s doing.” He tailors his word choice to the make-up of the class. Diagnosis is a familiar concept to these students, many of whom are interested in attending medical school.

Often taken as the first of many pre-med required classes, LS1a introduces Harvard freshmen to the academic life of a pre-med. While many of the students in the lecture hall believe that they will go to medical school, between one and two thirds of them will end up dropping the program.

The story of droves of students entering college expecting to be pre-med, but later switching tracks—whether because of the rigor or the draw of other disciplines—is a familiar one. However, at Harvard unique factors play into this whittling down of aspiring doctors.

Although Harvard offers a robust pre-med advising program in the Houses, many pre-meds struggle freshman year, when they say that advising is less structured. Later on, a variety of factors—from alternate disciplines and academic communities that are perhaps less grade-obsessed or more diverse, to more lucrative careers that require less up-front time investment—draw students away from the path towards medical school.

Learning The Ropes

The Office of Career Services estimates that a quarter of the incoming class each year is “exploring medicine.” This data is based on annual attendance at Opening Days events aimed at students considering pre-med and pre-health careers.

However, popular wisdom among Peer Advising Fellows says that the proportion is closer to 50 percent. “Half of them are pre-med, or more,” says Khin-Kyemon Aung ’14, who is a PAF and president emeritus of the Harvard Pre-medical Society.

OCS estimates that, ultimately, 17 percent of a given class will apply to medical school.

As is the case at most of its peer institutions, Harvard does not offer a pre-med concentration, secondary, or citation. Rather, the school suggests that students take a particular set of classes before taking the MCAT or applying to medical school.

Currently, most medical schools require students to take one year of biology, one year of general chemistry, one year of organic chemistry, one year of general physics, and one year of English. On top of these requirements, medical schools expect applicants to have leadership experience and strong extracurriculars.

These requirements offer some framework, but the open-endedness can leave students unsure of how to navigate their courses or envision what it means to be a strong candidate for medical school.

“They would like to come in here and have us just hand them a checklist,” says Robin Mount, Director of Career, Research, and International Opportunities at OCS. “But there isn’t the checklist for life.”

While all undergraduates benefit from advising, freshman pre-meds seem to be particularly in need of guidance. Myths abound regarding both Harvard’s pre-med track and the medical school application process.

Though OCS advises that there is no correct pre-med mold, Aung has noticed that many pre-meds spend freshman year trying to live up to what they believe pre-meds should do.

“You’re asking: ‘What should I be doing?’” Aung says. “Everyone’s very eager and enthusiastic and it’s great, but it also leads to individuals really wanting to follow the set path.”

Christian Ramirez ’15 entered Harvard expecting to be pre-med after spending time on his parents’ farm in rural Ecuador. He came face-to-face with the lack of health care in the region, which sparked the idea that he might want to later work for Doctors Without Borders.

So, falling in step with his fellow pre-meds, Ramirez enrolled in LS1a his freshman fall. Ramirez’s freshman advisor, with whom he had little contact, quickly approved his course selection.

“My freshman advisor really didn’t do much, to be completely honest. I don’t even remember his name,” Ramirez says. “He told me to take things that I already knew I had to take as a pre-med.”

In hindsight, Ramirez realizes that he should have instead taken the alternative course, Life and Physical Sciences A, a more foundational class that also fulfills pre-med requirements.

However, Ramirez explains that “people are coming into this with the idea that they’re too good for LPS A.”

After his freshman fall, Ramirez decided to quit the pre-med track when he realized he no longer wanted to be a doctor. On top of disliking LS1a, Ramirez also discovered a passion for studying classics. In making his decision, he did not reach out to Harvard’s pre-med advising network.

Although pre-med advising for freshmen exists in the form of OCS drop-in hours, pre-med events, and freshman advising (albeit without mandatory scheduled check-ins), the system requires students to be proactive about seeking advice.

“As a freshman, I had no idea what to do,” says Katie C. Gamble ’15, a social studies concentrator, Peer Advising Fellow, and former pre-med. She wears a sweatshirt after staying up late to finish a paper for a social studies course. “You definitely have to do some work to get access to the advising,” she says. “It’s great and it’s there but you have to know what you’re doing to get to it.”

Without a highly structured advising system, freshmen are more likely to worry that, for example, a bad grade in one class spells disaster for their medical school application. Their preconceptions about the model pre-med student are more likely to inform their decisions about classes, extracurriculars, and whether to be pre-med at all.

Kruti B. Vora ’17 volunteered at Newton-Wellesley Hospital the summer after ninth grade. She loved it and the experience inspired her to pursue a career in medicine.

However, two weeks into the school year, Vora says that she is still unsure how pre-med advising works.

“I don’t know too much yet about pre-med advisors and who I’m supposed to talk to specifically about pre-med advising,” Vora says. “I saw some things at the Activities Fair that would pair me with hospitals and volunteer activities.”

One such group is the Harvard Pre-medical Society, whose purpose is to be “a student-run organization at Harvard College committed to providing educational support and volunteer opportunities for the campus pre-medical community.”

Grace ’15, who was granted anonymity by The Crimson because she did not want her comments to affect medical school applications, decided to be pre-med sophomore year. She has noticed that Harvard’s peer pre-med advising cannot fill in all of the gaps left by an incomplete freshman advising system. “The Pre-med Society has to use their own people and they have juniors and seniors who mentor freshmen, but seniors and juniors haven’t applied to medical school, so it’s really just a shot in the dark,” Grace says.

Grace believes that if she had entered her freshman year as a pre-med, she would have dropped out. “I would have done all those things I think you’re supposed to do and wouldn’t have done the things I’m interested in like theater because I would have thought, ‘No, I have to do the pre-med stuff to get into medical school,’” Grace says.

Harvard’s pre-med advising is led by the OCS’s two pre-medical advisors, Oona B. Ceder ’90 and Sirinya Matchacheep. Students say that meeting with Ceder and Matchacheep can be remarkably helpful. But the two of them are responsible for all pre-med students at the College, not just freshmen, which means that younger students sometimes take a backseat to those who are currently applying to medical school.

“If you want an appointment with them, it’s often backed up for weeks,” Aung says.

The choice to have less structured freshman pre-med advising stems from Harvard’s philosophy that students should keep their options open freshman year, as well as its commitment to providing a liberal arts education.

“If we had pre-med advisors—this is the way everything is at Harvard—we’d have people saying where are the pre-law, where are the engineering advisors?” Mount says.

Once in the House system, students are each assigned a pre-med tutor, which results in more individualized guidance and support than freshman year. “Harvard’s pre-med advising within the House system is incredibly strong compared to other schools,” says Joshua H. St. Louis ’09, who is now in his last year of Tufts’ MD/PhD program. The House advising system offers assistance including mock interviews, personal statements, and advice on application deadlines.

However, many freshmen drop out of pre-med before they are even given access to the strong Harvard House advising network. At the cost of encouraging greater exploration, pre-meds are left largely on their own freshman year to grapple with the realities of being pre-med.

A Lack of Community

Many of those who have remained on the pre-med track find that there is a lack of community and pride among pre-meds. These students explain that strongly identifying as pre-med will lead peers to judge them as cut-throat, intense, and grade-obsessed. Therefore, they often socialize outside of the pre-med community, prioritizing their concentration or their extracurriculars.

“You want to express your passion for medicine, but you don’t want to be a stereotypical pre-medder,” says Anna ’16, a pre-med who was granted anonymity by The Crimson because she did not want her comments to affect medical school applications. “It creates a very anti-intellectual community.”

For Grace, being identified as pre-med takes on the form of an insult. “People are like, ‘Do you do social studies?’ And I’m like, ‘Oh my gosh I wish, thank you for thinking that. I wish I was that cool,’” Grace says. “It’s kind of a badge of shame to be called a pre-med.”

Because of the negative connotations surrounding the pre-med personality, many students on the track to medical school actively seek out the company of non-pre-meds. St. Louis says that as an undergraduate, he “found [pre-meds] to be super stressed out and always wearied.” He remembers working with a friend in Cabot Science Library on Friday afternoons alongside a table of pre-meds, sobbing and breaking down as they worked frantically up until the 5 p.m. problem set deadline.

St. Louis ultimately decided to distance himself from the pre-med community: Of his four roommates at Harvard, only one other was pre-med. Because his concentration—Organismic and Evolutionary Biology—and his roommate’s—Mind, Brain, and Behavior—were not the quintessential pre-med concentrations like Molecular and Cellular Biology and Neurobiology, they didn’t have much contact with pre-meds outside the required curriculum.

St. Louis says that many of his friends who were devoted to helping people wound up falling off of the pre-med track, whereas those who stuck with it were largely driven by money or parental pressures. “I felt like most of them weren’t really going into medicine for the same reasons that I was,” St. Louis says, referring to his peers who continued on the pre-med track.

Hillary ’13, who was granted anonymity because she did not want her comments to affect medical school applications, also expressed discomfort with the motivations of her fellow pre-meds. “You’ve got everyone trying to get A’s in a class where they give out like five to ten percent A’s and the rest B’s and a few Cs,” Hillary says. Although she stayed with the pre-med program, this mindset meant that she “didn’t want to be around pre-meds 24/7.”

Although Hillary originally declared MCB as her concentration, she later switched to History and Science, which she says has fewer pre-med students. “I wanted to experience other people, and experience other concentrations,” Hillary explains.

For some pre-meds, the fragmented nature of Harvard’s pre-med community causes them to rethink their intent to apply to medical school. “I think I’ve realized, if I really don’t like the pre-med culture, then med school is really just a bunch of pre-meds. That’s all there is...It makes me re-evaluate if that’s a culture I want to be in for the next however many years,” Grace says.

For Grace, this lack of camaraderie might be endemic to a program in which few  students are fully engaged in their coursework. “I think every concentration has one or two requirements people aren’t thrilled about but have to do. But pretty much every pre-med class, people aren’t excited about.”

A For Application

“One could argue pre-med students do obsess on the specificities of the grade,” Lue says, referring to his LS1a students. “Because pre-med students are worried about their ability to get into medical school, there may be a little bit more focus on that.”

Harvard’s advising staff emphasize that one or two bad grades will not sink a medical school application. According to OCS’s medical school admissions data, Harvard pre-med applicants with a 3.50 GPA or higher had a 93 percent acceptance rate to medical schools in 2012.

Ceder says that she sees “many students who come in with a couple of B minuses or a C+ or even a B or a B+ and they’re concerned that this is now going to keep them out of medical school.” Medical schools, she says, are more interested in “the passion vocation piece”—commitment to a sport, for example—than simply straight A’s.

But pre-med students are not just concerned about getting into a medical school: They want to get into the best medical schools.

As a result, students often choose concentrations and courses based on what will do the most to boost their GPA. “When you’re choosing Gen Ed, you’re choosing them to get A’s. Generally people will be like, ‘I just need the A for medical school,’” says Sasha ’14, who was granted anonymity by The Crimson because she did not want her comments to affect medical school applications.

In the lab component for some of her pre-med courses, Hillary encountered lab partners who were driven almost entirely by their medical school aspirations. “If you didn’t do the one extra question on the lab report, you were a bad lab partner and would bring down the whole group and then the whole group wouldn’t get an A and then everybody would be upset,” Hillary says.

One consequence of this obsession with good grades is a less intellectually diverse pre-med community. “I think they’re discouraging people who could potentially bring something new to the table in terms of scientific innovation,” Ramirez says.

If Not Med School…

Harvard students are also pulled away from the pre-med track by the appeal of more lucrative jobs, such as finance or consulting, which hire straight out of college. These career paths offer the dual incentive of high compensation and immediate reward. Students are looking at earning between $50,000 and $100,000 the year after graduation, rather than paying tuition for four years of medical school, followed by a residency of up to seven years.

Gamble, who was pre-med until the end of her freshman year, says that the delayed benefits of medical careers played into her decision to pursue an alternate path. In high school, she worked with a reconstructive surgeon. While learning the ropes, Gamble encountered a 35-year-old resident with two children, which “really threw [her] off,” Gamble says. She had trouble imagining herself trying to raise a family while still training for her profession.

She is now aiming to get a job in consulting after graduation. “It’s something I discovered that I really, really like a lot,” Gamble says. “I know I obviously want to do something I love, but I also want to make a fair wage.”

“I realized that kind of career timeline didn’t align with what I want in a career,” Ramirez says, echoing Gamble. “Time for me is really important, and I don’t want to wait until I’m forty.”

For those students who decide to delay applying to medical school—whether to take a break from academics, or to help finance their medical school tuition—the timeline to becoming a doctor is even longer. As a result, many Harvard students decide to get consulting or finance jobs because of the compensation, with the full intent of later applying to medical school.

In addition, these companies often don’t have any structured requirements for their entry-level positions. “I know people with no business experience who started consulting after graduating,” says Jen Q. Y. Zhu ’14, who decided to stop being pre-med with one requirement left.

Pre-med students have to weigh the cost—in both time and money—of pursuing a medical career against the attractiveness of other careers that can promise larger paychecks immediately.

Is it Worth It?

Clearly, not all pre-meds who enter Harvard expecting to be pre-med will graduate and go to medical school. According to Ceder, one of the OCS advisors, students must ask themselves, “Do I need the MD to do what I want to do?”

For many, the answer is no. Some have become disillusioned, others discouraged, the path to medical school looking less attractive than they had first imagined.

This shift away from the pre-med track is already apparent for some at 2:30 p.m., when  Robert A. Lue’s LS1a lecture is about to go overtime. A few students quickly pack up their bags and climb over their peers to head elswehere. Most, however, stay to hear the professor’s final thoughts. After all, the concepts might appear on a future exam.

After a few moments, Lue wraps up and Science Center B becomes fully alive again. Students huddle afterwards. Some talk about pre-labs. Others admit that they “weren’t paying attention the whole first half.”