The Cheese Grater.

The medical school application process is broken. In no way is this better exemplified than the secondary application process; or, as I like to think of it, the “cheese grater.”

Applying to medical school is done in multiple stages. The first stage is the primary application, which consists of sending essays (e.g., “why medicine?”), transcripts, and other demographic information to your list of chosen medical schools. After some bureaucratic wrangling by the AAMC — the “non-profit” behind this mess — medical schools send the secondary application to students who have sent their primary application.

The secondary application consists of, well, more essays. (Much to my chagrin, often the same information as the primary application.) The ostensible purpose is to allow schools a closer look at each applicant. For example, a common essay is “why us?” Schools will use this information to decide whether or not to send interview invites to students. Unfortunately, this seemingly-benign process has become an arduous process which I feel the need to complain about, as most people have little insight into this process.

Why it sucks

Terrible UI Schools have portals to submit their essays. As someone with basic design experience, the websites are horrifying. For example, here is how I was supposed to select prerequisite courses from one school:


Money: Each school requires a fee to submit a secondary. These fees range from $50 (e.g., Kaiser-Permanente) to $130 (e.g., Dartmouth). Thus, this step can cost thousands of dollars, just like the primary application. I can afford this because I am an over-paid software engineer. However, for many people, this is not affordable, and one of the reasons why medical school is mostly for rich kids.

Time: Writing one 1,500-character essay is not too bad. However, doing 20 of them is a nightmare. To prevent this pain, it is recommended to “prewrite” your secondaries by looking up past secondary essay prompts online. Often, the essays will not deviate too much each year. Unfortunately, I did not have the wisdom to follow this advice.

Ghosting: After sending the most heartfelt and intimate essays, one must wait months to hear a response. And there is no way to track the status of your application.

But you have to still do it

Applying to medical school is like rolling dice. It can appear arbitrary who is accepted and rejected. Moreover, I have no idea how the admissions committees will receive my application. So, the best strategy is to roll the dice as often as possible. The average number of applications last year was 18. I, a neurotic person, submitted my primary application to 41 schools and submitted secondaries to 28. (The difference between the two is the result of essay burnout, unwillingness to pay more in fees, and a realization that I did not meet some of the schools’ prerequisites).

How can we fix this?

Unfortunately, we can’t.

Fundamentally, there is a supply-and-demand problem here: there are more premeds than seats in medical schools. In 2021, for example, there were 62,443 applicants for ​​22,666 spots nationwide at M.D. institutions. Thus, each school has to screen out thousands of students; no matter the process chosen, the sieve must leave only a few remaining. It would be nice to reduce those secondary fees, but admissions departments rely on them. At any rate, secondaries are just one hurdle for those who want to wear a white coat.

I call the secondary process the “cheese grater” because you must take your identity and life history and shave off the aspects that medical schools want, collecting the remains in a neat essay to send. And, of course, it’s painful.


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