UO > Feature > Doctor Come-Lately

As the first child in any generation of her family to attend college, Deborah Clements, MD, dreamed of becoming a physician, but she didn’t choose a career in medicine as an undergraduate because “during that time [the late ‘70s] women rarely entered medicine unless they were from families of physicians, which I was not. I was further discouraged by my undergraduate adviser who told me I wasn’t smart enough to become a physician,” she says.

Clements, 46, an associate professor and the associate program director in the department of family medicine at the University of Kansas Medical Center, entered medical school at the age of 33 after working in a variety of jobs, including 13 years at Methodist Health System in Omaha, Nebraska, first as a human


	Deborah Clements, MD, the associate program director in the department of family medicine at the University of Kansas Medical Center, says, “I’ll probably die with a stethoscope in my hand and student loans yet to be paid, but I will have had the career of my dreams.” © 2006 Dan White

resources systems manager and later, as director of compensation.

Clements is typical of a breed of doctors who enter medicine after working in other careers. “It’s not a trend, but it applies to a fraction of the applicants we see,” says Harold Helderman, the assistant dean of admissions at Vanderbilt University School of Medicine in Nashville. According to Andrew Frantz, MD, the associate dean for admissions at Columbia University College of Physicians and Surgeons, a handful of the 150 people admitted to Columbia’s medical school each year are career changers. They come from fields as diverse as law, engineering, teaching, finance, and management.

Some of the “eventual” physicians intended to go into medicine from the start, but got sidetracked or delayed pursuing medical school. Others initially chose one career and later decided to switch to medicine.

Clements started her pre-med education as a biology major in college, but didn’t complete her undergraduate degree for another 13 years. She left college after three years, got married, became pregnant, and worked full-time to support her family. “Unfortunately, my education and my dream of medical school became less and less of a priority,” she says.

At the age of 30, she was widowed and “decided I’d put off my dream of becoming a physician long enough. I eventually went back to medicine because of the advice of another adviser. After my husband’s death, I decided I would not spend the rest of my days in front of a computer analyzing pay data. We were in the midst of a nursing shortage at that time and the hospital also had a college of nursing. One of the employee benefits at my job was paid nursing school tuition for full-time employees, so I decided that if I couldn’t be a physician, I’d return to school and get a nursing degree,” Clements says. “After my first semester, my nursing advisor suggested that she and the rest of the faculty thought I should apply to medical school because, ‘we really don’t see you taking orders from anyone.’ That was the gentle nudge I needed. I finished my premedical requirements that year, applied to one medical school and was accepted.”

David Krol, MD, is the vice president of medical affairs for The Children’s Health Fund, a New York City health advocacy organization. He was a professional baseball player in the Minnesota Twins minor league system for almost three years. “I didn’t go into medicine in the beginning because I had always had a dream of being a professional baseball player. When I was presented with the opportunity to fulfill my dream, I took it. I knew that I could always go back to school, but I couldn’t always be a professional baseball player.” He was released from the minor leagues after three years without playing in the majors.

When he left baseball, he had eyes for only one thing: a career in medicine. “I wasn’t interested in anything else. I didn’t want to go into business or law or engineering and I was very interested in health policy and trying to change our health-care system.” After his release, Krol did a stint as an assistant greens keeper on a golf course, loaded trucks at a Coca-Cola warehouse, and worked as a chemist at a wastewater-treatment facility. “Those weren’t careers—just jobs to make money for medical school during the time between baseball and the start of the academic year,” he says.

According to the Association of American Medical Colleges (AAMC), of the roughly 17,000 people who enter medical school each year, about five percent are older than 30, and less than one percent are older than 38 upon entrance. The average age of medical students entering their first year of medical school has hovered around 24 for the past two decades.

According to Frantz, the age upon medical school entrance doesn’t make a lot of difference unless someone starts school in their 40s vs. their 20s. He says that although older students often have more maturity, better focus, and more social experience, Columbia is reluctant to accept someone 40 or 50 years old into medical school because “it’s harder for older people to assimilate information. There is also the added consideration of how long will they be in service in medicine?” he says.

While “older” medical students can feel set apart from their just-out-of-college fellow students, Susan Skaff Hagen, 31, an MD/PhD candidate at the University of South Carolina School of Medicine, who entered medical school at the age of 28, says that being the oldest female in her class isn’t a problem. “I haven’t really allowed age to interfere with my relationships with my classmates. Some are still one step from college and enjoy frequenting bars more than I do. The beauty of medical school is that there are a variety of people to meet with similar schedules and there are plenty of people who enjoy similar things to me.”

Yet, her life experience does sometimes set her apart from her classmates. “Some of my classmates had never lived on their own and did not understand the demands of life—grocery shopping, laundry, cooking,” says Hagen. “They were asserting their independence while trying to learn a massive amount of information. Some say learning in medical school is like drinking a sip of water from a fire hydrant. I had a good balance on my personal life prior to entering medical school which made me feel much more grounded,” she says.

While Krol wasn’t the oldest in his class, “I did feel like I had seen and experienced more than many of them by not going straight through from college.” Clements, who entered medical school at 33, says that in her class, the average was 25 and there was one student older than her and about five students between 29 and 33. “I can’t say that I was more or less prepared. I was just differently prepared. I knew more about time management, for example, than my younger classmates.”

Leslie Brott didn’t plan to become a doctor. Brott, 41, who practices family medicine at Physicians’ Medical Center in McMinnville, Oregon, graduated from college with a BA in history and taught high school ESL (English as a Second Language) in Texas for nine years before attending the University of Texas Health Science Center in San Antonio.

While she loved teaching and came from a family of educators, she realized she needed more. “Teaching ESL was a joy, but the content itself was not challenging. There are always challenges with the students and administration, but those weren’t intellectually challenging. I felt that I would thrive with a career that caused me to be continually learning and updating my knowledge base. Medicine is always changing and to be effective one has to be as up-to-date as possible on the newest and best theories and practices.”

Once she realized she needed a career that demanded more intellectually, Brott explored other options. “Medicine seemed like such a natural choice that I wonder why I didn’t choose it originally. The human body and mind have always fascinated me,” she says. “A career helping others was clearly a goal and medicine just seemed to fit.”

For Brott and others, however, the issue of the science requirement looms large. How do medical schools’ admissions boards see career changers? “If their undergraduate education was strong, we treat their application the same [as those with pre-med backgrounds],” says Joanne McGrath, the assistant dean of admissions and financial aid at New York University School of Medicine. “If not, then we suggest they do post-baccalaureate work in science or a master’s in science and then apply to medical school.”

At Columbia, catching up involves one year each of biology and physics and two years of chemistry. “Our humanities majors do just as well as others from science backgrounds,” when it comes to fulfilling the science requirement, says Frantz. At Columbia, students can go to the Columbia School of General Studies to fulfill the science requirement.

Because Brott majored in history in college, “I took only the bare minimum in science to graduate from college and I had many pre-med classes to take. I didn’t think I could “do” science. I quit calculus in high school and never took math again in college. I took basic, basic science classes the first time in college as I had no confidence in my ability to succeed in science. Knowing that if I wanted a career in medicine, I had to take those classes, I jumped in.” For her pre-med classes, she started with biology. “I loved it. A lack of a science background is not a barrier to entering medicine. You just have to do it.”

Brott moved to her home state of Oregon and took pre-med classes to make up for her lack of a science background. “I really couldn’t afford to just attend college, so I started working again in the public schools. I taught ESL and Spanish at a small high school for five years while I took my pre-med classes at a university in Portland.” But, attending classes at night and during summer term made Brott feel “completely out of the loop with regard to pre-med advising, so I had to do my own navigating of the medical school entrance procedures. I found it rather difficult to be a part-time pre-med student, unable to interact frequently with other pre-med students and completely unable to meet with an adviser.” Since she had the summers off, she was able to complete many credits during summer terms. During the school year, “Time management was my friend and having some flexibility at work helped as well, as I could leave at 3:30 to get to my evening classes,” Brott says.

Hagen, who majored in Spanish in college and taught Spanish for three years says, “I felt disadvantaged because I was not as prepared to enter medical school with a seven- to eight-year gap between when I finished my undergraduate work and medical school. I felt removed from the rigors of learning basic science.”

Krol majored in biology in college, but had to brush up on science nonetheless. “I was on a pre-med track so I was prepared to enter med school. Though, because I didn’t take my MCAT until after my playing days were over (five years after freshman biology and chemistry), I had to re-learn all of that stuff. It was a busy summer of studying after I was released from the team.”