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General Premedical Requirements

So you’ve decided to embark on the path to become a doctor – ultimately to serve people in need, to touch the hearts of those in trouble, to listen to the stories of a patient’s life, and to make a difference in the lives of the people you meet. But before you can get there, there is the path with the landmarks of obtaining an MD degree, completing residency training, and passing national licensure examinations. The first step, before all of this can happen, is a formidable array of minimum requirements, including:

• A Bachelor’s Degree by the time of matriculation (with rare exceptions*) in any major of discipline from an accredited institution of higher education (United States or Canada)
• A undergraduate GPA ranging from a minimum 2.7 for Caribbean medical schools to 3.7+ for Canadian and U.S. medical schools.
• A competitive score on the standardized MCAT (Medical College Admissions Test) of at least 28+ (~77th percentile) for most medical schools.
• In general, one year of pre-requisite courses including: General Biology with Laboratory, General Chemistry with Laboratory, Physics with Laboratory, Organic Chemistry with Laboratory, Calculus, and English. Possible additional pre-requisites include a half-year of: Biochemistry, and Statistics.**
• Two or more letters of recommendations, may be required from university faculty

In addition, applicants often apply with exceptional extra-curricular activities, including:

• Research work and/or scientific publications
• A variety of volunteer experiences, some of which may be abroad or in under-served communities
• First-hand exposure to health care and medical work
• Paid Employment

*Some schools accept exceptional applicants in their 2nd or 3rd year of undergraduate studies.
**Individual program pre-requisites may vary depending on the medical school. Check with the institutions prior to applying.

Applying to Medical School (Canada)

Generally, medical students begin their studies after receiving a bachelor's degree in another field, often one of the biological sciences. However, not all medical schools in Canada require a bachelor's degree for entry. For example, Quebec's medical schools accept applicants after a two-year CEGEP diploma, which is the equivalent of other provinces' grade 12 plus the first year of university. Most faculties of medicine in Western Canada require at least 2 years, and most faculties in Ontario require at least 3 years of university study before application can be made to medical school. The University of Manitoba requires applicants to complete a prior degree before admission. The Association of Faculties of Medicine of Canada (AFMC) publishes a detailed guide to admission requirements of Canadian faculties of medicine on a yearly basis.

Admission offers are made by individual medical schools, generally on the basis of a personal statement, autobiographical sketch, undergraduate record (GPA), scores on the Medical College Admission Test (MCAT), and interviews. Volunteer work is often an important criterion considered by admission committees. Medical schools in Quebec (Francophones and Anglophone alike), the University of Ottawa (a bilingual school), and the Northern Ontario School of Medicine, do not require the MCAT. Some schools, such as the University of Toronto and Queen's University, use the MCAT score as a cut-off, where sub-standard scores compromise eligibility. Other schools, such as the University of Western Ontario, give increasing preference to higher performance. McMaster University strictly utilizes the Verbal Reasoning section of the MCAT to determine interview eligibility and admission rank.

Applying to Medical Schools

Common Applications, such as the OMSAS (Ontario Medical School Application System) and AMCAS (American Medical Colleges Application System), are central processing sites that students use when applying to the medical schools, such as in Ontario and for most schools in the United States. Students fill out their application form and send their transcripts and reference letters to these centralized application systems, which will then distribute the application package to the medical schools that the applicants have selected.

Ontario medical schools (6 in total)
http://www.ouac.on.ca/omsas/

• Online application available from mid-July
• Must have an account registered by September 15th
• Submit completed applications, send official transcripts (via postage mail), and complete Confidential Assessment Forms by October 1st
• Release MCAT scores from the AMCAS THx system to OMSAS by October 13
• Submit 3 reference letters by December 1st
• Application portion completed by students includes personal profile, academic grades, a sketch (extracurricular activities, volunteering, employment, athletic participation, etc), and specific essay components for selected schools
• Your grades will be converted to an OMSAS value (GPA format)

Application fees: $285 for the first school + $75 for each additional school + $10 transcript requests (most schools)

US Medical School via AMCAS:

• Application begins June 1
• Remember to release your MCAT scores from the AMCAS THx system to AMCAS
• Will process official transcripts (via postage mail)
• Will process reference letters via postage mail and or electronically
• Application components: personal profile, academic history (schools attended, courses, grades, time taken), reference letter information, post-secondary experiences (up to 15 items each with maximum of 1325 character description, with spaces), one autobiographic essay (5300 character limit, including spaces)
• Application fees: $160 for first school + $32 for each additional school

Supplementary (Secondary) Applications (US):
After evaluating your AMCAS application, some schools will send you a secondary application to complete (electronically or on paper) and you have to send it directly to the school, not via AMCAS, along with the required fee.

Interview and Admission Decisions:
In the US, most medical schools are on a “rolling” basis where applicants hear about interview and/or admissions decisions throughout the application season, rather than on a set date. But do not confuse rolling admissions and a rolling interview system, some schools that have fixed admission dates may have rolling interviews. Generally, this implies that students who submit their application earlier will hear about an interview/admission decision earlier.

Cost of Applications:
With every step of the application process, there are usually associated costs. Beginning from the MCAT exam, to applying to schools, to travelling to interviews, the total costs associated with the medical could rise to thousands of dollars.

MCAT registration fee	$235
OMSAS application (6 schools) or AMCAS (15 schools)	$660
Secondary applications (15 schools)*	$1200
Travel to interviews (6 schools)**	$2400
Totally (Ontario)	$3295
Total (US)	$4495

*US only; average $80
**Variable prices (depending on location, transportation, accommodations): conservative estimate $400

How to Choose a School

Currently, there are 134 LCME-accredited MD programs in the U.S. and CACMS/LCME-accredited MD programs in Canada.

Here are some guidelines to choosing a school:
Determine which schools you are eligible to apply

• Residency status (citizenship, state/province of residence)
• GPA and MCAT score cutoffs
• Years of undergraduate schooling completed or degree attainment
• Course prerequisites

Develop a list of schools at which interests you

• Mission of the school and your own goals
• Components of education and curriculum layout
• Teaching styles and learning opportunities available
• Financial commitment (tuition, books and feeds, cost of living, loans, scholarships)
• Location of school

Prioritize the schools based on your preference and competitiveness

• GPA and MCAT scores
• Medical related experience
• Research experience (especially for universities that have a heavy emphasis on research)
• Diversity of experience (especially or schools that stresses on a diverse student population)

The number of schools that students apply to generally depends on their application’s competitiveness. The stronger the applicant, the fewer schools he/she applies to because of the likely success of their solid record. Generally, most people apply to around 17 schools, more if they feel their folder is weaker in comparison. Most applicants’ portfolios consist of 20-30% “reach” school, places where chances of an acceptance is a stretch; 10-20% “safeties”, places where there is high likelihood of acceptance; and 50-70% in the middle, places where the applicant is in the competitive pool. Keep in mind that medical school’s in-state/province preferences could shift the chances of success just as an out-of-state/province status does.

Ultimately, it’s important to apply to schools where you’d like to go to if you were accepted. Keep in mind that you will not only spend four years there, but may also do your residency at their affiliated hospitals as well. It wouldn’t be advisable to apply somewhere where you wouldn’t want to live or at a program that is unappealing to you. Additionally, the cost of education is another factor that should be taken into consideration. Some schools offer generous financial subsidizations in the form of loans, grants, and scholarships (need-base or merit-base); other schools, may have more restrictive regiments, depending on your citizenship, state/provincial residence, and personal profile.

How to Pay

Medical school is an incredibly expensive endeavour. In Canada, students can expect to pay anywhere from $3,102 (Université de Montréal for Quebec residents) to $20,831(McMaster University) a year - and that’s only if you’re a Canadian citizen or permanent resident. The tuition for non-Canadian citizens or permanent residents at the same Canadian medical institutions is $8,501 and $108,546 per year, respectively!

The story in the U.S. isn’t any better. According to the 2007-2008 AAMC Annual Student Tuition and Fees Report, the average tuition and fees for incoming medical students attending a public school ranged from $22,199 per year (in-state residents) to $40,919 (out-of-state residents). The average private school tuition ranged from $39,964 (in-state residents) to $40,368 (out-of-state residents). Taken together, the average indebtedness of a U.S. medical graduate is $157,944 and over 78% of graduates have a debt of at least $100,000.

So how can you afford the tuition for medical school? Listed below are multiple ways in which to secure enough money to pay for medical school.

In Canada:

Internal Scholarships/Grants/Bursaries: Many Canadian universities have a diverse number of scholarships reserved for students enrolled in their Faculty of Medicine. Aside from the rare exception, the scholarships are not of extraordinary value (most are less than or equal to $1,000) and are aimed towards outstanding students in a particular field of study, demonstrated by academic excellence during select medical school courses or clerkships. A word of advice: do not rely on these to fund your education.

External Scholarships/Grants/Bursaries: Scholarships not affiliated with a particular Faculty of Medicine and can therefore be used at any (Canadian) university. To name a couple, the RBC Royal Bank Scholarship ($15,000 for students of medicine and dentistry; 6 awards, of which 2 are reserved for RBC bank clients; holistic application) and the John and Lois Lamont Graduate Scholarship (single $2,600 award for medical students interested in pursuing a career on sexual and reproductive health; essay based) are notable examples.

Canadian Forces Medical Officer Training Plan (MOTP): Available to Canadian citizens only. Provides full subsidization of tuition, textbook, medical instruments and other mandatory costs associated with attending medical school (up to 3 years at a Canadian medical institution) in addition to an annual salary ranging from $44,244 - $58,284 per year as a medical student. The catch? MOTP students must undergo training as a Family Physician and serve in the CF for 4 years after completion of their family medicine residency training (i.e., for 6 years after medical school), in addition to completing all mandatory CF basic/officer training. Furthermore, MOTP students may be posted to any CF Base Medical Clinic location and will likely be deployed at least once on a six-month tour.

Provincial Action Plans (ex/ Alberta Rural Physician Action Plan): Offers subsidized education (from partial to full subsidization) often in return for meeting specific criteria and future Return-in-Service agreements (such as, in the case of the Alberta RPAP program, practicing as a primary care physician in rural Alberta for 3 years).

Provincial/Canada Student Loans (ex/ OSAP): All Canadian citizens/permanent residents or visa students studying in Canada are eligible for participation in the provincial-Canadian student loan assistance programs. Generally speaking, the exact same as undergraduate student loans but with a higher overall lifetime limit. Importantly, students studying abroad are not eligible for the provincial portion of the student loan; however, students can still receive the Canadian/federal student loan portion ($210/wk or about $8,400 a year).

Student Line of Credit: Ensure that you are getting a Professional Student Line of Credit (i.e., for Medicine) from a reputable bank - this drastically raises your overall lifetime loan limit from $40,000 average to $200,000 at all Big 5 Banks (BMO, RBC, Scotiabank, CIBC, TD), while providing additional bank-specific professional benefits (such as free student banking or premium VISA/Mastercard credit cards with no annual fees). Arguably one of the last resorts for funding your education due to the interest rates.

External Sources: Including employment, friends, and/or family.

In the U.S:

Internal Scholarships/Grants/Bursaries: Similar to Canadian universities (see Canadian section), although with higher monetary values reflecting increase tuition costs. A few universities offer full-ride scholarships for top notch students or to all students (as in the case of the University of Central Florida), often with no preference as to their citizenship (such as Vanderbilt University and Washington University). Others guarantee scholarships to every admitted medical student (such as the Mayo Medical School), or cover only tuition (such as the Cleveland Clinic Lerner College of Medicine program for Case Western Reserve University).

External Scholarships/Grants/Bursaries: Scholarships not affiliated with a particular Faculty of Medicine and can therefore be used at any university.

Medical Scientist Training Program (MD/PhD programs): Many universities in the U.S. offer free tuition and a stipend for students enrolled in their respective MD/PhD program. These spots are generally extraordinarily competitive and are offered only to proven top-notch student-researchers; virtually all are only available for U.S. citizens/permanent residents.

Health Professions Scholarship Program (HPSP)/Military: Available to U.S. citizens only. Provides full subsidization of tuition, textbooks, medical instruments and other mandatory costs associated with attending any accredited U.S. medical institution (M.D./D.O) in addition to a monthly stipend of ~$2,060. The conditions in exchange for HPSP differ from Canada, however, including a mandated 45 days of active training per year of scholarship and a 1:1 Return-in-Service agreement with a minimum of three years of active duty. Furthermore, all HPSP candidates must apply through the military match service for residency training, although most specialties and subspecialties are covered (i.e., HPSP candidates are not obligated to become primary care physicians).

National Health Service Corps Scholarship: Available to U.S. citizens only. Pays for tuition, required fees and some other educational costs for up to 4 years at any accredited U.S. medical institution (M.D./D.O) in addition to providing a monthly living stipend of ~$1,289. In return, NHSC scholars serve a 1:1 Return-in-Service agreement (minimum 2 years of service) at a high-need Health Professional Shortage Area (assigned through competition) and must serve a primary care residency.

National Health Services Corps Loan Repayment Program: Available to U.S. citizens only. Offers $50,000 to fully licensed primary care physicians (M.D/D.O) in exchange for 2 years of service in a community-based site at a high-need Health Professional Shortage Area. Can apply for additional years of support after completion.

Federal Student Loans (Stafford Loans): Available only to U.S. citizens/permanent residents and offered by the U.S. government. Subsidized Stafford Loans at a lower interest rate only available to those with a demonstrated financial need. Annual loan limits of $20,500 for professional programs ($8,500 subsidized/$12,000 unsubsidized).

Institutional Student Loans: Offered by the University, generally only to U.S. citizens/permanent residents. Interest rates, loan limits, and repayment plans vary depending on the institution.

Student Line of Credit: Similar to the Canadian counterpart (see Canadian section).

External Sources: Including employment, friends, and/or family.