BS/MD Programs – Are they Worth It?

Medical school admissions are getting more competitive than ever, and it takes over a decade to complete training. If you could save time, money, and stress in order to get there, would you? I’m going to try and explain what Accelerated BS/MD programs are, their history in the United States, their pros and cons, and if you’re considering pre-med, whether you should go into these types of programs. I’ll try and back up everything that I’m claiming using peer-reviewed sources and my own experience to make sure that this is as authentic as I can make it

Historical Overview

BS/MD programs have been around for a long time, and they have many iterations and names—€”it may be a bachelor’€™s of science or a bachelor€’s of arts (BA) with an MD or a DO. These programs often tout the advantages of reducing student stress through admission to a medical school and decrease the time spent in school (if they are seven years). As you can imagine, they were (and still are) competitive to get into even if students did know that they are interested in going into medical school. In the United States, there are many programs which offer this type of connection between undergraduate pre-medical years and medical school years.

The first combined baccalaureate-M.D. program started in 1961 at Northwestern University, followed by a similar program in Boston University, and then a 1963 program at Pennsylvania State University and Thomas Jefferson University that was five years, and finally a 1964 formation of a program at Rensselaer Polytechnic Institute in conjunction with Albany Medical College. These have been followed by a slew of medical programs, the specific nature/rankings can be found on many college preparatory websites. These programs hope to take an exceptional group of high schoolers, expose them to a liberal arts curriculum which teach humanism and patient care, and accelerate their learning of clinical knowledge in order to move them into medical practice sooner and therefore help alleviate the physician shortage and help undeserved communities get much-needed clinical care. I’€™ll definitely write about whether they are achieving their goal in the current day and age, but that’€™s a topic for another blog post.

Advantages

In 1910, long before BS/MD programs were formed, Abraham Flexner changed pre-medical curriculum in the United States by establishing the rigorous science-based curriculum that still exists today. Unfortunately, as more people have shown interest in this curriculum, they have started to try and game the system in order to €œ”show”€ or €œ”demonstrate”€ that they have the character development needed to become a physician. In the metaphorical “rat race” to become a physician, people have forgotten that the “hidden pre-medical curriculum”€” one of competition, obstacles, and ticking the boxes of research and volunteering to strategically demonstrate that one has career interest du jour” is still very much in vogue. BS/MD programs definitely alleviate this competition tremendously.

The main portion of a BS/MD program is to make sure that you have the opportunity to explore what you like to do. For example, I was able to get my “feet wet” in things that I didn’t know that I would like and things that I learned that I didn’t. I was able to stress less about my GPA and focus more on the development rather than the demonstration of my character, and learned what really interested me. I can’t speak for the medical school portion, but I can point to studies which have shown no significant differences between BS/MD applicants and traditional MD applicants (done at Northwestern University’s HPME program). This does vary, however, and each medical program is different, but others have shown a similar effect. For example, in the University of Missouri-Kansas City’s (UMKC) 6-year medical program, a study measured clinical performance by measuring “problem solving, critical thinking, clinical abilities, and rapport with patients,” through a five-point scale. The integrated 6 year curriculum provided significant clinical integration (as was its’ goal) and produced resident physicians who were significantly more competent than those who were not from UMKC.

Another advantage is an alleviation of the financial burden that is associated with college—at least one year. This may seem like a minor advantage, but remembering that each year of college may be as expensive as $60,000, it does make a difference to many people who are applying to university as a pre-medical student and are concerned about the rising cost of college.

What about residency placement after medical school? That differs from program to program, however, there hasn’t been much data collected about this particular phenomenon. Anecdotally, in my BS/MD program, there haven’t been much differences between traditional students and the students who have gone through the accelerated program. Furthermore, their career maturity wasn’t questioned as much either. This hasn’t been confirmed in an evidence-based manner, but it would be of particular interest moving forward and may be something to look into if you are particularly precocious and know what area of medicine you would be interested in. This anecdotal advice has been supported by others as well here and here.

The most alluring option comes with the security of medical school being in your hands without having to get a high MCAT score and GPA traditionally required by most medical schools in the United States. This is the best part of the program, hands-down for me. As a student who was stressed about maintaining focus in academics and extracurriculars in high school, this personally gave me the chance to realign priorities, figure out how to write about what interested me, and have time to think about things broader than the one path of medicine (pre-med, med school, residency, job). Medicine doesn’t occur in a vacuum.

Disadvantages

Like everything in life, things come with disadvantages. The BS/MD is no exception. To me, the disadvantages are minor, but they may affect your choice depending on your situation and aspirations. The academic rigor may be intense (depending on the program), you may be less prepared for medical school, and you’re locked into the medical school that you have been accepted to and cannot explore other options. All these disadvantages stem from the program itself, and so I cannot talk about all of the programs as a whole, but there are some misconceptions in these statements.

The first two claims stem from the fact that a student who has been admitted to the undergraduate institution may find themselves inundated by the pressures brought on by the college work. Furthermore, it assumes that there may or may not be a BS/MD advisor at the school. Varying curricula have different standards. For example, at the Penn State program, you need to have a certain minimum score (a 126 in each of the four sections of the MCAT) while at others you do not need a specific score at all. Some advisors for BS/MD programs are great and allow some wiggle room in regards to the standard GPA cutoff in order to be eligible for the program, others are draconian and cut off whoever drops below a hundredth of a point.

The work is as intense as you make it. The type of student which is chosen for a BS/MD program typically is able to complete the work assigned to them on time and able to critically analyze and balance their time effectively. Furthermore, students go on to medical school and delegate the same time management skills that they have cultivated throughout high school and college to medical school as well. I will say that I have noticed a decrease in my own work ethic as time went on in college due to choosing easier courses, however, it was by my own choice that I have pulled back the effort and choosing to ramp up the pace will be a doable, and very manageable choice going forward when I enter medical school.

However, the reason I mentioned both of these disadvantages is because they were supported by the evidence. A study that analyzed causes of academic underperformance in medical school cited entering medical school via an accelerated pathway as a reason for academic risk. The authors postulated that this was due to biological maturity rather than a lack of knowledge. However, as they admit later on in the paper, “the contribution of ‘conscientiousness’ to early academic success  while intriguing remains relatively unaddressed.” This ability to do a task well can substitute for maturity when the student has a breadth of clinical experiences before entering medical school—these may include shadowing, internships, or research. After conversations with other students who have gone through the same BS/MD program, they have echoed this sentiment—experience trumps academics, developing conscientiousness by promoting decision-making heuristics which may help also develop maturity. Furthermore, another study mentioned that traditional students had “coped with the tasks of career crystallization and specification, whereas the students in the accelerated program were still in the process of doing so. Traditional medical school students appeared to be more advanced regarding formulating a general preference for a career in medicine, developing their vocational identity; they also had a greater ability to convert a generalized preference into a specific preference for a career as a physician.”

Finally, the most important disadvantage to talk about would be what I like to term the “locked-in fallacy.” Firstly, it is true that for most BS/MD programs, you lose your guaranteed seat if you apply out of the program. There are some notable exceptions—WUSTL and REMS (Washington University at St. Louis and University of Rochester 7-year programs) do allow students to apply out and retain their seats but they are also notoriously draconian about their requirements. The FAQ of the WUSTL 7-year program mention that students need to keep a 3.8/4.0 GPA and achieve a 97th percentile score to retain their guaranteed admission into medical school. If you want to apply to a better medical school, you’re going to have to do well in your undergraduate career—that’s not what the focus of these programs are so it is something that you will give up. But, it depends on your aspirations—do you want to try for a better, more prestigious medical school at the risk of not getting into that desirable top 20 medical school? If you can understand the flip side and choose based on your interests and your drive to do medicine when you are 18 is strong enough, I would say that a BS/MD program would be perfect for you.

Conclusions

Should you go into a BS/MD program? Depends on your priorities. The evidence shows that students who are accepted do well and continue to do well in their careers, as seen in a study done reviewing 26 years of the Penn State-Thomas Jefferson program. Physicians went on to have similar careers to their peers, with significantly more of the accelerated group seeking out full-time faculty appointments than those who were not involved in the accelerated program. Personally, I’m a little biased, as I’m part of a BS/MD program. But, as I hope I’ve shown through evidence and through my own experiences, it’s worth it (for me) as a pre-medical student both from a financial and educational perspective. As you can see, there are advantages and disadvantages, as in any choice, however, whether you value exploration or security or are dead set on becoming a medical doctor, BS/MD programs provide a great pathway from high school to become a physician in the United States.

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