What price do DOs pay for delaying medical school?

There are financial and career consequences to delaying matriculation, and students should know about them before they decide to take gap years.

Editor’s note: This is an opinion piece; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA.

For some, the timeline for getting into medical school is fairly straightforward: finish high school, go to college for four years and then enter medical school.

For others, that timeline will be different. Many students are choosing a path that includes a gap in between undergrad and med school matriculation. The current average age of a medical school matriculant is 24.

According to the Association of American Medical Colleges, there were more than 10,000 more applicants to U.S. medical schools during the 2018-2019 school year than during the 2008-2009 school year, a roughly 25% increase. The acceptance rate at U.S. medical schools ranges from 2% to 21%, according to U.S. News and World Report, which adds up to the competition being fierce.

Many students are deciding to take a few years off to strengthen their application before applying. During this time they might take more classes, get a master’s degree, retake the MCAT, or get health care experience by working as a certified nursing assistant (CNA) or an EMT.

This trend is detrimental to the health care field. There are both financial and career consequences to delaying medical school, and students should know about them before they decide to take time off before med school.

Starting at 22 vs. 26

Take two med students: one who enters medical school directly at 22 and the other who enters at 26 after working for four years as a CNA. Let’s assume they both graduate medical school in four years, complete a three-year emergency medicine residency and then practice until they are 65, then retire.

The 22-year-old student will be an experienced practicing physician for four more years than the 26-year-old student. And those four years are added on at the end of their career, which is when they are the most experienced and, one could say, the most valuable to the health care system because of the knowledge accumulated throughout their career.

If the age of new doctors keeps rising and the retirement age stays the same, the health care system will be losing years and years of high-value physician labor.

What should change

One way to address this issue would be to encourage premeds to apply straight from undergrad and help them make their applications strong by the end of their junior year.

I’d also love to see medical schools start looking at applicants in a different way and place less focus on a student’s MCAT and GPA. Can we instead examine each applicant like an osteopathic physician would examine a patient, assessing their mind, body, and spirit and looking at them as unique individuals rather than a set of symptoms or test scores? Doing so could lead to fewer students taking years off to work on their MCAT score or otherwise become more competitive applicants.

Many osteopathic medical schools are already doing this to some degree, as are some MD schools. Also, in 2015 the AAMC released a revamped MCAT that was designed to better assess applicants’ well-roundedness. Let’s build on this trend and take it further.

The financial cost of years off

Going back to our 22-year-old and 26-year-old students: the 26-year-old who worked as a CNA for four years likely earned around $30,000 during each of those years, giving him or her a gross income of about $120,000 during the break in education.

The 22-year-old who went straight into medical school had four additional years of working as a physician at the end of their career, when an emergency physician can earn $350,000 annually, for a total of $1.4 million in additional earnings, or $1.3 million more earned across their career than the 26-year-old matriculant.

For most doctors, money isn’t the reason they go into the field of medicine. Nevertheless, their lifetime earnings should be a consideration.

Benefits of years off

Despite these consequences, there are some potential benefits to taking years off. Some people say that the extra time will make individuals more confident in their choice to become a physician, which could decrease their likelihood of dropping out.

Another potential benefit is that older individuals could have more life experience which could lead to them being more well-rounded physicians.

However, I did a brief search for data to support these statements and did not find solid evidence suggesting that these benefits are widespread among those who take time off before med school.

In the end, the decision to take years off before medical school is complex and will depend highly on an individual’s unique circumstances. Students should, however, be aware of the potential consequences of delaying matriculation. What are your thoughts on delaying medical school? Please let me know in the comments below.

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  1. Annie P

    Hi Nathan! I graduated college after 4 years, went directly to get my masters for 2 years, then matriculated into medical school right after. On one hand, I wish I would have felt confident enough to apply directly after college. At the time, I wasn’t even 100% if I wanted to pursue this path or other avenues in healthcare. The pressure of deciding my career, the MCAT, and applying to programs was so daunting for me as I was starting my senior year of college, I didn’t think I was a good enough candidate. In fact, most of my friends from college and high school who pursued medicine also took 1-3 years off. Some sought graduate programs, while others worked.

    On the other hand, graduate school gave me the opportunity to better understand myself as a student and person. Afterwards, I felt prepared to apply for medical school. I’m a proponent for gap years because there was a lot of personal development during that time that I believe has made me a better medical student and future physician. I think if you feel confident to apply for medical school right after college then you should be viewed based on merit, not your age.

    This is an interesting article because I don’t think we discuss this trend enough in medical education.

  2. David Shumway

    I’m a third year osteopathic medical student. In defense of taking gap time, I feel I was much more mature and better prepared to handle the rigors of medical school starting at 25 than I was when I graduated college at 22. In that time, I was able to get the life experience you mention in the article working some very non-medical jobs, definitely echoing your point that made me more sure of my choice to go to medical school. I was also able to get married, save a good amount of money to help pay school expenses, and basically enter school on a very strong foundation. Was I good, high performing student in college, and could I have managed starting medical school at 22 or 23? Yes, I’m probably sure I would have adapted. But I feel like I was able to learn better who I was, make some of the stupid mistakes all young people make when the stakes were lower, and develop the support system and coping skills I think that are priceless to surviving residency and becoming a good physician. Like you said above, every situation is unique, and in my case the gap time was priceless. Therefore, while I agree it is important to consider the costs of starting medical school late, I offer the converse argument that students that don’t feel ready for medical school and want to strengthen themselves in other ways before they start not be pushed into earlier matriculation just because they are worried about the economic opportunity costs.

  3. Walter Hartwig

    Thank you for taking the time and effort to write an original position essay on this topic. I can comment from the perspective of medical school admissions, as I have served in this capacity for several years.
    At our program we consider there to be several ADVANTAGES to applicants who take a structured gap time between college graduation and entering osteopathic medical school.

    Objectively you are correct that a later start to career can mean fewer years ‘on the job’ and thus contributing to the workforce. However, this logic would suggest that we should not admit women to medical school because the census data very clearly show that on average female physicians work for fewer years than do their male counterparts. We do not support this, of course.

    Our program outcome data clearly show that students who take extra time to complete medical school because of dual-degree programs, receiving fellowships, extending their research efforts, etc. fare very well in the residency match. These choices empower them to be future physician leaders and practice more comprehensive health care. We believe that the same applies on the front end – applicants who commit themselves to community-based training and work efforts prior to applying (such as Teach for America, Peace Corps, etc) bring an outstanding perspective to their commitment to medicine.
    We believe they are likely to continue that commitment by practicing a primary care form of medicine, consistent with our mission.

    1. Laura

      Thanks Walter for sharing your perspective as a medical school admissions officer. As a post-bacc who hopes to attend an osteopathic medical school and eventually practice primary care, I’m encouraged to read about the advantages nontraditional students bring to the field!

  4. Emelia

    I also applied to medical school later in my twenties, and I think that – overall – the benefits are enormous. Medicine is not only about how much money you can make in your lifetime, and the experiences that are brought from a previous career or volunteer commitment will only serve to benefit patients and contribute to the functioning of a complete healthcare team. It is definitely not “detrimental” to the healthcare field.

    As a personal example, I was a cardiothoracic surgery ICU RN before medical school, and was able to pay off my undergraduate loans, care for patients and learn pharmacology and pathology hands-on, get married to someone who – it turned out – is able to work while I am in medical school (decreasing the financial burdens of med school), and pay for all my pre-req classes out of pocket. I think experiences like these (previous career, stable relationship, stable finances) upon entering medical school may help to decrease the Imposter Syndrome many students feel when they go straight to med school from undergrad and, in general, increase self-esteem and confidence in their own success.

    So far, my experience has been extremely beneficial to learning the material and possessing context for the basic and clinical sciences. While you made a clear economic argument for going to med school from undergrad, there are many paths to medicine, whether you are going straight from undergrad or taking a more circuitous route, and they should all be celebrated.

    1. Alicia

      Emeilia, I was also a nurse – medical ICU – before matriculating to medical school. I worked as a nurse for five years. I can only second everything you said about how much you can learn before starting medical school.

      Working the ICU, I felt extremely solid on drugs that affect autonomics as well as medications and treatments for diseases of the respiratory and cardiovascular systems. It paid off in spades – when I was tested on these subjects, they were some of my highest scores with the least amount of studying.

      Being a nurse gave me a huge leg up over my peers. I feel like I had more time to relax, pursue my hobbies, and have fun, while my peers were studying for 5 or 10 hours every day. I think my medical school experience would have been much less enjoyable if I hadn’t had all of my previous work experience.

  5. Brooke

    I may be an outlier, but I want to present the benefits I’ve noticed from starting med school later at age 28 as a current 33-year-old first-year resident. I am 100% happy that I worked as a nurse for 5 years (traveling and working abroad for 3) before starting the grind of med school and residency, even as a female interested in a family. I find my real world experiences help me everyday to strongly connect with my colleagues and patients. Friends, I can’t recommend highly enough choosing before med school and residency to take time to explore the world, and to know yourself and what brings you joy, and to have some practical, real world experiences before starting on this path because it’s easy get swept up in it and for life to become a big blur. There are some ways to pause while you’re in it, but it can be challenging to stop the moving train of medical training. You can always earn more money, especially later in your career, but you can’t get your 20s back. I’m happy to answer any questions about my experience starting later in medicine.

  6. Student Doc Lee

    I’m an OMS-I and started at 27 years old. I did lose out on making more money in my overall career, but I wouldn’t say I’ve lost out on experience. I decided late in undergrad that I wanted to become a physician and began taking premeds as a junior. I realized that most of the material I was learning was a foreign language, and albeit a beautiful language, it was complex and took time to solidly grasp. With no clinical experience to gauge my passion for the field, I began working at the local hospital during school. Although not high paying, I realized I truly loved patient care, even on the really bad days! I ended up working at the hospital for four more years after graduation, enjoying my work. When I was ready, applying to DO schools felt like coming home. Perhaps I took too much time, but it was time that I needed to grow, to mature, and to live. Becoming the first physician in my family has been a long road, but I know who I am now, and that in itself is worth the journey.

  7. J.M.

    I totally disagree with most of this article. The thing that is the most detrimental to the profession is people entering medical school because of some idea that its the path to prosperity or parental pressure and they end up in the wrong schooling, wrong career path, and resent all of it because they didn’t take the time to figure who they were, or enjoy life a little bit before starting the rigors of med school.
    It’s difficult sitting next to people in class who still have their parents making Dr’s appointments for them because they dont know how, yet are training to be a physician.
    I am >30yo and a current OMS. I didn’t go back to college until 23, worked in public safety for the better part of a decade paid for undergrad out of pocket, no debt, lived a life and had 3 almost 4 gap years while my wife and I were starting a family, and it was the BEST thing I ever did. I know exactly why I am here, and have no need to question it. Med school is tough. From what I’ve seen the ones that have the most trouble with the commitment are the ones who didn’t do anything besides school leading up to it, or never worked a crappy thankless laborous job and have no reality of how difficult just living is for some people out there. There is no timeline for this process. You will be fine financially. I don’t think a couple 100k dollars is going to make that big of a difference in my life when I’ve been practicing for who knows how long. Go to med school when its right for you.

    1. Laura

      J.M., the reasons mentioned in your second sentence for attending medical school define my ex’s path which eventually resulted in his getting kicked out of residency. I never got a clear answer from him as to why he was kicked out, but he told me his mom pushed him into becoming a doctor when he never wanted to be one in the first place. He is my ex and not my significant other because he was unsupportive of my reasons for pursuing a post-bacc. While I agreed with him that some people glamorize the profession (like his mom), I felt like his lack of support was due to his bad experience. No doubt med school is hard, but if everyone got kicked out of residency like he did, we wouldn’t have doctors! Ex has been at a job he hates for over a decade since getting kicked out and does not want to start a new career after paying off a decade’s worth of debt. Maybe he would have benefited working for 1+ years after graduating college.

  8. Nick

    Hi OMS Holmes, thanks for offering your opinions about introducing students into the world of medicine at an earlier age and the benefits it can yield. While I took time after my undergraduate education to further develop my application/self before attending medical school, I wonder if this is a topic that should be addressed earlier in one’s education? Should we be focusing on developing the skills and understanding of oneself/medical culture in late high school and early undergraduate curriculum? This is hard to say as the environment surrounding us as we age has such profound impacts on who we become. I pose this question to you: are you truly able to know if gap time before medical school would have benefitted you if you did not take said time? I think that this answer is decided on an individual basis. Some individuals are academically, mentally, and emotionally ready to embark on the road to a medical career once they graduate undergraduate education. Others may fit all of these criteria, yet they desire a broader understanding of the world around them, so they take time before entering medical school. Some may be lost completely, yet they find inspiration during their time away from academia which brings them to medical school. I truly believe this is what makes medicine great. Differing life experiences bring depth and breadth to our understanding of the mind, body and, spirit.

  9. Moshe

    Older students are twice as likely to finish medical school in the top 20% of their class, when compared to students entering with similar grades.

    Kumwenda B, Cleland JA, Walker K, et alThe relationship between school type and academic performance at medical school: a national, multi-cohort studyBMJ Open 2017;7:e016291. doi: 10.1136/bmjopen-2017-016291

  10. Laura

    Post-bacc student here with a strong interest in osteopathic medicine. I have heard from other medical students/physicians that someone who starts medical school after taking time off from college is often much more well rounded & mature. I entered college immediately out of high school with no interest in medicine as I was burnt out from math & science classes. After realizing the educational & counseling career paths I envisioned in high school & undergrad were not for me, both my work in schools (some underserved) & as a veteran patient have allowed me to find my true calling in medicine. I have seen many doctors who didn’t care about me as a person, just a chart. And those who didn’t care likely spent most of their time in school rather than the work world! The best doctors are those who have an excellent bedside manner, not who went to prestigious schools. Both my current job as a medical receptionist at an outpatient mental health clinic & former teaching jobs have provided many encounters in dealing with difficult patients/students/parents. I turn 30 in 2 weeks & honestly I’m more motivated to pursue challenging science courses now than I was in my teens/early 20’s. Finally, I agree that med schools should stop putting so much weight on GPA/test scores. I have a 3.6 GPA & have always been an excellent student but not as excellent of a standardized test taker.

  11. Concerned OMS2

    To the aspiring pre-med students feeling discouraged and self-conscious about the content of this article please remember — Every writer is entitled to their opinion and it cannot be overstated that this is an opinion piece and does not reflect the views of the AOA or MSUCOM. I wish the author, at the very least, disclosed that there are many aspects of this issue that have not been properly considered.

    Many students that are low-income, first-generation, people of color, or otherwise disadvantaged do not have the ability to and/or privilege of starting medical school directly from undergrad. All of our journies are unique and equally legitimate. If the author is unaware of this and perhaps is blinded by his/her own privilege I encourage him/her to read the following article: https://www.nytimes.com/2019/11/25/health/medical-school-cost-diversity.html
    OR seek out a non-traditional applicant at your school and ask about their experience or research the many articles and studies relating to the prohibitive costs of medical school for underprivileged students.

    The value of a physician isn’t based on how much money they earn in their career or how many feasible and productive years they can contribute to the field. It has become clear, as of late, that physician mental health is in jeopardy and suicide rates are at their highest so let’s focus on making sure we have healthy and fulfilled physicians who make the sort of difference in patients’ lives that cannot be quantified.

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