Some had an inkling that they wanted to become physicians at a young age, but self-doubts, poor study habits or life circumstances got in the way. Others discovered their medical calling after many years in other professions.
Each with a unique story, students who begin medical school in middle age or older face high hurdles but often experience tremendous personal satisfaction. Many are motivated by the desire to care for the underserved, make a difference in their communities or more fully leverage their cognitive abilities for the greater good.
The osteopathic medical profession is known for attracting nontraditional students who’ve had previous careers. But even so, fewer than 1% of current DO students started osteopathic medical school after age 40, according to the American Association of Colleges of Osteopathic Medicine (AACOM). And fewer than 1 in 1,000 students enrolled after age 50.
For several years, the average age of new osteopathic medical students has been between 24 and 25 years, only slightly higher than that of first-year allopathic medical students.
But the age range of DO students is considerable. New osteopathic medical students in 2012 ranged from 18 to 61.
Some of the oldest students say they applied to DO schools after being rejected by MD schools or were discouraged from applying to MD schools in the first place. The Age Discrimination Act of 1975 prohibits age-related bias by programs and activities accepting federal financial assistance, including medical schools. Nevertheless, discrimination both overt and subtle remains, a number of older students maintain.
According to AOA records, several dozen osteopathic medical students are expected to graduate at age 50 or older, and a few will be in their 60s. Of the AOA’s roster of living osteopathic physicians, more than 200 graduated when they were at least 50 years old.
For some of these older students and physicians, a career in medicine was a natural segue from a related occupation. For others, it has been a bold departure from prior schooling and work.
Not out of reach
Clarence L. Nicodemus, PhD, DO, became the first 60-something new osteopathic medical graduate in 2004, when he earned his degree at age 61 from the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing. A biomechanical engineer for three decades, he had been the director of spine research at the University of Texas Medical Branch in Galveston for several years when he decided to go to medical school.
Working with orthopedic surgeons, he had developed instruments for the surgical repair of spine damage, but he was becoming increasingly interested in nonsurgical methods of alleviating back pain.
“The reason I went to osteopathic medical school was so I could do manual medicine,” says Dr. Nicodemus, now 70 and an AOA-board-certified specialist in neuromusculoskeletal medicine and osteopathic manipulative medicine in Monterey, Calif.
He applied to MSUCOM after having a conversation with the late OMM titan Philip E. Greenman, DO, who was then an associate dean at the school.
“I was presenting my spine research at a meeting of the American Back Society, and Phil Greenman was president of the society at the time,” Dr. Nicodemus remembers. “I approached him and asked, ‘Do you guys take old farts in as students?’ And he said, ‘Yes. With your background, you’ll be great.’ ”
Patrick W. “Bill” Conway, OMS IV, who is 61, had been a psychological clinician for many years before seriously considering a medical career.
With a master’s degree in divinity, Conway had been a Baptist minister who did a great deal of pastoral counseling, as well as a hospital-based psychotherapist and substance-abuse counselor. Planning to get a PsyD degree so he could become a licensed clinical psychologist, he served a psychotherapy internship during which he took a number of classes alongside psychiatry residents.
“The psychiatry residents told me, ‘You don’t think like a psychologist. You think like we do,’ ” Conway recalls. “They said, ‘You want to know what is physically wrong with your patients. You want to understand their diseases. You should go to medical school.’
“They assured me, ‘You’re not too old—you’re experienced. And that will help you more than you know.’ ”
Although influenced enough by these physicians that he began looking at med school catalogs, Conway did not immediately heed their advice, plagued as he was by long-held doubts.
“I didn’t have an academic background in science, and math had always been an obstacle for me,” Conway says. “And despite doing quite well in graduate school, I feared that no one would take me seriously as an older applicant.”
Growing up in a working-class family in Colorado, Conway had been interested in medicine at a young age but was discouraged from this pursuit. “My parents were skeptical that ordinary people like us could enter what they assumed was a career reserved for the wealthy,” he says.
But not long after he finished his psychotherapy internship, his mother died and his father disclosed that he had a terminal illness. “It’s not until the people who bring you into this world start to die that any of us really understands that we are going to die too,” observes Conway, who attends the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine. “I realized that my resident friends were right—life is too brief and too precious to waste doing anything but what you love.
“I told my wife, ‘This isn’t going to let me go.’ And she agreed.”
Medicine wouldn’t let go of Laura Ford, OMS II, either. She continually found a way to knock down every obstacle keeping her from advancing her medical training.
Now 51, Ford got married at 17 and didn’t start college until a decade after high school. Working while attending community college, Ford and her husband, who was in construction, were struggling financially. She joined the U.S. Army so she could continue her schooling.
Trained as an operating room technician, she later became a physician assistant because she wanted more responsibilities. “I knew that being a doctor wasn’t within my means at the time, and I didn’t want to be a nurse,” she says.
During her first years in the Army before going full time to PA school, she was working in the OR and attending college while home-schooling one of her children. “To do this, I worked double shifts on weekends and one day during the week,” she says.
As a PA, she was deployed to Nicaragua after Hurricane Mitch struck in 1998 and to Kosovo two years later. “I provided a lot of medical care to the villagers,” she says. These experiences fueled her desire to become a physician.
After leaving the Army in 2002, she planned to attend medical school. But working long hours, she found it impossible to squeeze in the prerequisite science courses. Switching to the evening shift allowed her to take her organic chemistry and physics classes and eventually enroll in medical school, a full lifetime later than a typical medical student.
A victim of downsizing during the recession, 54-year-old Billy Murchison Jr., OMS II, lost his job as an applied chemist.
“Like a lot of guys my age, I found myself unable to find another job in my field,” he says. “What little savings I had, I ran through pretty fast.”
Lacking adequate health insurance, Murchison ended up going to a federally qualified clinic in Memphis, Tenn., his hometown. This experience drew his attention to the health challenges of the underserved.
“And a crazy idea came to me,” he remembers. “I said to myself, ‘Maybe I could do something about this. But isn’t it 30 years too late?’ ”
Then 50, Murchison called a couple of medical associations, including the AOA, to see if someone his age would have any chance of getting into med school. An AOA staff member assured him that osteopathic medical schools have students in their 50s. “Previously I thought my chances of getting into med school were nil,” he says.
Because he had already taken all the prerequisite science courses in college more than 20 years prior, Murchison took the MCAT without much preparation. He scored a 23.
So he found temporary work in applied chemistry to survive financially and began retaking science classes. Scoring a 29 the second time he took the MCAT, he was accepted into the William Carey University College of Osteopathic Medicine (WCUCOM) in Hattiesburg.
Leslie Bardessono, OMS III, is another career switcher. She liked science in high school but did not have a clear sense of what she wanted to do when she entered college. She ended up majoring in geography because she loved the courses.
“I finished college without a career goal in mind,” says Bardessono, 50. Because she likes children, she obtained a teaching certificate and taught elementary school for several years.
“During that time, I discovered that I particularly enjoyed teaching math, science and health. So I began looking at possible careers in health care, including physical therapy and chiropractic,” she says.
At the urging of some physician friends, she began to consider a career in medicine. “I gave it a lot of serious thought and figured I would regret not trying,” says Bardessono, at student at the Touro University College of Osteopathic Medicine—California (TUCOM-CA) in Vallejo.
“One reason I didn’t start earlier is that I never thought that med school was accessible to someone who wasn’t super wealthy or super brainy,” she explains. “But as I got to know more doctors, I realized that while they’re smart, not every single one of them is a genius.”
Osteopathic medicine is the third career for MSUCOM student David W. Lee, OMS III, who is 59. In college, he was a biology major but he didn’t do well. Dropping out in his junior year, he took a customer service job at an automobile dealership. But after a few years, he went back to school and earned a psychology degree and then an MBA.
His automotive experience led to a job with Ford Motor Co. He climbed the corporate ladder, ending up as the national marketing manager for transmission parts. Taking an early retirement package, he left Ford after 28 years.
In his last couple of years with Ford, he had been volunteering as a reserve police officer. “Through doing that, I found that I really enjoyed helping people with their problems,” Lee says.
As soon as he retired from Ford, he entered the Police Academy and became a sworn police officer, a career he enjoyed for a few years.
Meanwhile, Lee’s mother, who was in her 90s at the time, suffered from congestive heart failure and other health problems, and he accompanied her on many trips to the doctor and the hospital.
“In these medical settings, I just kept feeling that I was on the wrong side of the counter,” Lee says. “I thought I should be on the other side because that’s what I’d like to do.”
Because being a police officer can be a physically demanding job, Lee began to reassess his long-term career plans. “I re-evaluated what I wanted to do for the next 20 years. And that’s when I made the decision to go into medicine,” he says.
Some older students applied to a few med schools and got in on the first try. Others applied to multiple schools over several years before snaring an acceptance.
Some knew from the onset that they wanted to become DOs, while others pursued osteopathic medicine after receiving rejection letters from MD schools. But all put tremendous thought and effort into the process of getting into a medical college.
Still, the persistence needed to get in pales in comparison to that required to get through med school, some of the older students say.
For Dr. Nicodemus, the biggest hurdle was the huge amount of memorization that was expected in the first two years and the fact that he had completed his science prerequisites decades ago. “While most of my classmates had recently graduated from college, where they had taken biochemistry and other science courses, I hadn’t taken these courses in 30 years,” he says. “Plus, all of a sudden, I had to really focus on coursework and testing.
“At the end of the first semester, I was hanging on by the skin of my teeth, thinking, ‘This is quite a challenge.’ But I felt I was up to it.”
To survive the first two years, Dr. Nicodemus had to retrain himself to be a better student. He developed strategies that would capitalize on his intellectual strengths while compensating for his age-aggravated weaknesses.
“The material wasn’t above my understanding. It was just difficult for me to assimilate it all in a short period of time,” he explains.
Unlike when he pursued his engineering degrees, he couldn’t read material once and remember it well enough to pass a test a week later. “In med school, I had to reread the material and become clever in the way I studied to maximize the probability of my passing a test,” he says. “In other words, I couldn’t study everything, and I didn’t.”
Conway, who is a 61-year-old fourth-year like Dr. Nicodemus was, also found the classroom years of med school quite difficult.
“Medical school for me was not easy,” he says. His academic adviser allowed him to take five years to finish, so he would have more time to complete his coursework, as well as a psychotherapy book he was co-writing.
Like Dr. Nicodemus, Conway had to relearn how to study. “Medical school is not about how well you can memorize but about how well you can put things together and learn to think clinically,” he says. “No one can memorize everything med students are supposed to learn in those first two years—it’s impossible.
“Nobody has that kind of ability. But what we do have is the ability to connect the dots between the material and start to put things together in a way that is useful.”
Murchison initially also struggled to keep up with the coursework. “In my first semester, I thought I was going to fail because it was just so different,” he says. “During our orientation, our school’s dean used this analogy: ‘You have been used to drinking out of a pitcher. Now you are walking up to a fire hydrant and drinking straight out of it.’ That turned out to be accurate.
“But I adjusted after the first semester, and since then I’ve been fine academically. I’m not at the top of my class, but I’m not at the bottom. I’m comfortably in the middle.”
Lee didn’t find the coursework overly challenging, but he did have trouble memorizing information. “I find that compared to my peers, many of the younger students have a very good ability to memorize things,” he says. “I don’t memorize things well. I really never have.
“The way I have to learn is to study the material to the point where I completely understand it and can explain it to somebody else. This helps me recall or reconstruct enough of it that I can perform well on exams.”
Though they may have accumulated deeper financial reserves, older students have greater financial burdens than their younger counterparts.
As a middle-aged couple, Murchison and his wife have medical and other expenses younger students and their spouses typically don’t have. Murchison, who is financing most of his education with loans, worries about being $300,000 in debt when he finishes.
“I asked myself, ‘How am I going to take care of it? Do I really want to go this far at this point in my life?’ But for me, it was a no-brainer.
“I’ve always been the type who if I believed in something, I was going to do it. I want to live my life without what-ifs. I’ve been blessed that I got into med school. And I intend to stay in.”
Dr. Nicodemus, who was making a six-figure salary as an engineering professor in Texas, had some savings but not enough to cover four years of medical school. He was able to work part time as a faculty member in MSU’s college of engineering while he attended med school and, as a result, paid in-state rather than out-of-state tuition and earned a stipend. Still, he needed loans.
Bardessono, who is divorced, receives a little bit of alimony and child support but needed student loans to cover tuition and related expenses at TUCOM-CA. To her consternation, she discovered that familial circumstances do not affect the amount of money a med student can borrow.
“My son started college this year, and my daughter is a junior in high school, she says. “But the amount of your student loan can’t go beyond the cost of your attendance, which is the same for everyone. There is not a sliding scale. So if you have a family of 10, you would get the same amount as a single person.
“For me, as a single mom, it has been a struggle. I don’t have a family who can help me out financially. And during the first two years, with all of that academic work and having my kids at home with me then, there was no way I could work. The financial situation has been very difficult.”
Although he has a pension from Ford Motor Co., Lee’s pre-retirement long-term financial and tax planning did not include four years of medical school tuition. He has taken out student loans to minimize the tax impact of making premature withdrawals from his retirement accounts.
“By thus conserving funds, I will be better situated to practice in an underserved area.” He is planning to apply for the National Health Service Corps’ loan repayment program.
Triumph of experience
Despite significant obstacles, those who begin med school later in life are usually motivated to finish, having made great sacrifices to realize their dreams. And some older students have found that their age and experience have served them well in many circumstances.
“In the second two years of med school, I really began to shine,” Dr. Nicodemus remembers. “It’s a whole different world. It’s about relating to patients. Not only did I have problem-solving in my background as an engineer, but I also had life experience.
“I could relate to patients at any level because I’d had similar experiences at some point in my life, being 60 years old at the time.”
Conway points out that certain classes were easier for him than for his classmates. “Medical jurisprudence was a breeze for me,” he says. “I loved it. People who kicked my backside in anatomy would come up to me and say, ‘Bill, I don’t understand this material. How do you get this stuff?’ ”
Having majored in history and political science as an undergrad and studied theology as a grad student, Conway says “conceptual material” comes very easy to him. And he says his background enables him to relate to people on a number of different levels.
Like Dr. Nicodemus, Conway believes patients find it comforting that he looks and acts more mature than the typical med student. “They seem to open up readily to me,” he says.
Because of her clinical experience as a PA, Ford has found that she expects more out of her classes than some of her classmates do, and she has sought out additional clinical experience in the community. “I was really excited about learning, but I wanted to put what I was learning into effect,” says Ford, who attends the Ohio University-Heritage College of Osteopathic Medicine in Athens. “I think it is not just about the end result but about the process.”
Interested in practicing family medicine and OMT in a rural underserved area, Ford is a recipient of the Albert Schweitzer Fellowship, for which she has been doing a 200-hour service project to meet the needs of medically disadvantaged individuals in Athens.
Forced to juggle multiple professional and family commitments in the past, Ford notes that she has good time-management skills. “Because I have the experience already, it has allowed me to balance everything better,” she says.
Lee has found his background in customer service and sales to be tremendously helpful in patient care. “A large part of what we do in bringing patients to health is selling,” he explains. “We sell them on the program, the drug, the exercise and whatever else they need to get better. If you don’t do a good sales job with that, they’re not going to buy it.”
His experience as a police officer has also been beneficial. “One of the skills I developed is how to interrogate people,” he says. “When we talk to a patient, we don’t call it interrogation; we call it taking a history. But the process is similar. You need to ask probing questions. And just as in police work, patients are in a place they don’t want to be.
“They are afraid that they will be confined in a hospital, just as in police work they are afraid they are going to be locked up in jail. In addition, just like suspects, patients have information that they may not want to give you, such as private thoughts about their inner problems.”
‘The great leveler’
“If there has been a landmine to step on, I’ve managed to step on it,” Conway says. “But I’m still walking around. I still have both of my legs.”
Although he graduated with his class, Conway still has the remainder of his final rotation to complete before he can receive his diploma. He then plans to serve a traditional rotating internship before going through the match next year.
“Older students have to demonstrate their long-term commitment to medicine,” Conway says. “All of us have undertaken this process because we want to contribute to the health and well-being of others as physicians. That’s precisely what I intend to do, right up until the very moment I take my final breath.”
Older med students are forced to go to greater lengths to prove their capability, as well as their dedication.
“The biggest misconception people have is that medical school is for the young and energetic and if you’re older, you can’t do the work,” Conway says. “In reality, medical school is the great leveler.
“It’s not age that makes medical school difficult. Medical school is difficult no matter how old you are. Medical school is demanding and makes you tired, whether you’re 25, 35 or 55.”