HealthApril 23, 2020

Mistake or needed break? Taking a year off before medical school

By: Michelle A. Finkel, MD

During my third year of medical school, my growing sense of disquiet crossed a threshold. I had felt burned out for a while, but it was finally time to do something about my increasing restlessness. I was attending Harvard and learned that the institution had what was at the time a novel option for taking a year off during medical school called the "Five-Year MD Program." I would postpone graduation for a year with only a few-hundred-dollar tuition increase while pursuing a scholarly project.

I took the opportunity, writing for a newspaper as part of the American Association for the Advancement of Science Mass Media Fellowship and traveling internationally in three continents. By graduation, I had benefited from fascinating cultural experiences, developed new skill sets, enjoyed a fresh perspective and renewed my enthusiasm for medicine.

Taking a year off before medical school is more common than doing so during medical school, but in either case, temporarily eschewing academic coursework for other pursuits has become a popular option for some students. However, there are important professional, financial and personal implications to consider before making such a consequential decision.

Professional considerations

Most medical school candidates start the application process after their junior year of college and finish by senior year. Being in the thick of school and on campus makes connecting with pre-medical committees and faculty letter writers easy. On the other hand, for those taking a year off before medical school, it is harder to access faculty, and it may be that, with time, professors who would have been enthusiastic might not be quite as invested in helping a former student. One strategy is to approach faculty before the year off, but candidates then need to reach out to professors again the following year when they actually need those letters written.

Another application issue to consider is whether taking a year off before medical school is going to support your candidacy. It can go either way: Heading to Club Med for twelve months is clearly not going to make you a stronger applicant. On the other hand, bolstering your clinical experience is a way to leverage the time off to your advantage, affirming your decision to enter medicine even as it makes your application more compelling and unique. Be aware that procuring meaningful, solid work for the time off — whether research, clinical or some other robust role — takes work, foresight and advance planning. Many summer positions are already being filled by the prior winter.

For those with suboptimal GPAs or MCAT scores, taking a year off before medical school — or two — might be not just advisable, but also necessary for a successful application. According to the Association of American Medical Colleges (AAMC), mean medical school matriculants' total GPAs and MCAT scores for the 2019-20 cycle were 3.73 and 511.5, respectively. Excelling in a good post-baccalaureate program can bolster a pre-med's candidacy, and retaking the MCAT after a poor showing may help.

Financial considerations

I have heard taking a year off before medical school called a $150,000 mistake (although considering the lost years of compound interest, that number seems very low). The idea is that starting a year later in a medical career is lost income that cannot be recovered. The AAMC reports that the average medical school debt is over $200,000, a whopping number for a 20-something-year-old, especially one who is just starting out in residency, which affords a very low hourly rate. Thus, postponing a year of income by taking a year off (assuming what you are doing is not as remunerative as medicine) is a negative factor to examine seriously.

Personal considerations

There are many good personal reasons for taking a year off before, during or after medical school. First, training to be a doctor is a long and arduous process, and pursuing other interests is hard to do during medical school and residency training. For those who are not sure they want to pursue a career in medicine, jumping right in might be a big mistake. According to a 2018 survey of physicians, only 26% of doctors would be likely to recommend the medical profession to their children or other family members, and according to the Medscape National Physician Burnout and Suicide Report 2020, 42% of physicians report that they are burned out. Taking extra time to reflect on a career in medicine and spending time working with patients to see if it is as appealing as it sounds is a wise choice for some students. Those who still select medicine after time off and sincere reflection may find that they are better able to cope with the rigors of medical school and training in the coming years.

Taking a year off during medical school was a welcome reprieve from the narrow nature of medicine for me. It paid personal dividends while prolonging my shelf life in an often grueling medical career. In making the decision to take time away from formal coursework, professional and financial considerations are important, but make sure to lend great weight to the personal ones as well.

Michelle A. Finkel, MD
Lippincott® Medicine
Lippincott is a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions with a full suite of essential medical products, from books and journals to digital solutions.
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