Gaining entrance into a US medical school is very difficult. The prerequisites for entrance to these schools as well as the competition for available seats select for very few individuals. The hard working top students that have completed all the entrance requirements are typically the ones selected to these positions.
There are two subsets of potential medical school applicants who desire to have an alternative pathway to medical school. Those individuals who remain unselected in spite of good grades and good scores are one subset and those who did not immediately start down the road in college to become physicians are the other.
Many excellent prospective physicians might have not developed the high grade point average (GPA) necessary to compete for medical school entrance but would still make fine physicians. Other applicants might have matriculated in different types of occupations and now want to change their course to become physicians. Individuals in this category include chiropractors, physician assistants, pharmacists, PhDs and nurses.
Some of the above noted professionals might not have prepared for or completed the medical school entrance tests (MCATs). Some do not have the complete set of all required undergraduate courses necessary to apply for medical school entrance. Many in this category are reluctant to redo undergraduate courses for two more years for only the chance to apply to a medical school. For these people, there are alternative pathways to become a US physician.
Osteopathic Schools
Osteopathic schools allow a matriculant to graduate with a D.O. degree (Doctor of Osteopathy). A D.O. degree allows the holder to practice medicine in every way that an M.D. degree allows. Residency education (specialty education necessary to gain license to practice medicine in every state) is available to all D.O. participants. In general, D.O. degree holders are every bit as competent and capable as their M.D. counterparts in whatever specialty they have completed.
Gaining access to an Osteopathic medical school is currently somewhat easier than access to an Allopathic (M.D.) medical school due to less competition. This pathway is therefore a good alternative for those with a slightly lower grade point average. There are minor limitations to be considered with a D.O. degree. Some top allopathic residencies (M.D. residencies such as neurosurgery or orthopedic surgery) are not as available to D.O. graduates and the competition for positions in other residencies may allow only limited access. There are however separate and distinct very good osteopathic residencies that are reserved strictly for doctors of osteopathy.
Foreign Medical Schools (International Medical Graduates-IMEs)
These schools are typically “for profit” schools and found in foreign countries such as Mexico, Europe and the Caribbean. The education in these schools is probably less rigorous than in American schools but nonetheless, with hard work, a good medical education can be obtained. Typically, the student spends the first two years in basic science studies at the home school and then the last two years in clinical rotations. These rotations may be performed in the home country or in the case of Caribbean schools, in the USA or in England. The graduates of these programs obtain an M.D. degree.
International medical graduates (IMGs) will have a more difficult pathway to become American physicians. These graduates have to pass multiple tests (the USMLE) and then gain an ECFMG certificate which certifies them as being qualified to match with an American Residency program. After overcoming these hurdles, IMGs have to be selected for a USA residency program in a program called the match.
There are 24,034 allopathic residency positions and approximately 1000 Osteopathic residency positions available each year. There are 17,364 graduates of American medical schools and 3,631 graduates of American Osteopathic schools every year. The American medical school graduates are given first choice in any allopathic residency programs and likewise the same is offered for the Osteopathic graduates in their particular programs. The IMG is generally the last one to be chosen which means that a very limited number of positions are available. There are significant numbers of IMGs applying for very few positions. Less desirable residency positions (due to location, specialty or program history) are typically taken by the IMG.
Transfers into American Medical Schools
There is another pathway that students of foreign schools (and occasionally of osteopathic schools) can select. American medical schools have rare positions available in the second and third years as American students do occasionally drop out or postpone a semester. Transfer into an American medical school is therefore possible. The requirements to transfer are very high as the competition is intense. Equivalency tests that are similar to the National Boards required of American students are used to determine the fitness of the candidate. The scores must be in the top ten percent of those of American students and letters of recommendation from the current school professors must be of the highest order.
Completing the Education
It must be remembered that even when entrance is granted to any particular school, the amount of work required from the student is prodigious. The costs of school can reach beyond $200,00.00 and the amount of time devoted to long hours necessary to study and learn the crafts of medicine can be daunting. Nonetheless, the time and devotion to learning is well worth the price in my opinion as there is nothing to compare to the mastering the mass of knowledge and the satisfaction of personal interactions. In short, the price to be paid in treasure and time is well worth the final outcome.