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Q. What is the best school for premed: Cornell, Duke, Northwestern or Dartmouth?A. Why rankings are meaningless, followed by rankings. All four schools you listed are outstanding, highly regarded and have excellent record of sending well-prepared (well credentialed) successful applicants/matriculants to medical schools. And you stand a better chance of getting admitted into their own highly ranked medical schools (except Cornell’s is in NYC, not Ithaca). Choose one that fits you.Undergraduate medical school acceptance rate stats are meaninglessCM’s Top 10 Universities for Pre-Med Students (College Magazine)Top Premed Colleges (college.lovetoknow.com)by MCAT and GPAby Student ApplicationsBest Universities for Pre-Med Students: List of Top Schools (Student.com)Colleges That Produce the Most DoctorsPre-Med Choice of Undergraduate College Does Affect Med School Chances: What to ConsiderTop 20 Pre-Med Schools in America - Education AmericaUndergraduate medical school acceptance rate stats are meaninglessMany parents of aspiring doctors have asked me how they can choose the optimal college for medical school acceptance. The answer is simple -- there is no answer.By David Thomas, Photo by Damon SacksRecently, the mom of a high school student asked me if I could, as an educational consultant, supply her with a list of colleges and universities that had high rates of acceptance to medical school. She had found a number of them via Colleges That Change Lives. She stumbled onto others via internet searches.In my capacity as both a college and medical school admissions consultant, I have been asked to supply lists like these many times. The problem is always the same; it's impossible.Why? Many colleges boast high medical acceptance rates that are practically meaningless, since each school uses its own methodology to calculate the statistics, creating wildly misleading results.Some colleges only calculate the number of students who were accepted to medical school using the college's officially sanctioned Pre-Med Committee. So if 100 students declare freshman year that they are applying to medical school, 50 drop out after not doing well on prerequisites, 20 get a high-enough GPA to qualify for a Committee Letter, and 18 of those 20 get into medical school. So the school claims a 90% acceptance rate, but could as easily claim a rate of 18%. Cornell is a great example of a school like this.But wait, it gets more complicated. Some of the students apply without a committee letter -- let's say 30. And 10 of those get in, meaning out of the ACTUAL APPLICANTS to medical school, 28 out of 50 got in, which yields a 56% acceptance rate. So depending on how you look at it, 18%, 56% or 90% of Cornell applicants get into medical school.And of course, some colleges do not have a Pre-Med Committee. In those cases, schools usually publish simple acceptance rates. Because of the statistical gamesmanship, these schools can appear to have worse rates of acceptance but actually have BETTER rates!The sad truth is this; MED SCHOOL ACCEPTANCE STATS ARE UTTERLY MEANINGLESS. Medical school admissions usually starts with a computer-screening process, and computers don’t weight GPAs differently (at least, not yet). In other words, a 3.9 GPA from Fresno State will always trump a 3.5 from Cornell in this process. Once the Secondary Essays are received, and humans begin to get involved in the screening process, then the subjective factors are considered (as in all admissions).So what is important? DO WELL AS AN UNDERGRAD—wherever you are. How well you do in college is more important than where you went to college. And the existence of a premed committee doesn’t necessarily mean that you’ll get better advising there. In fact, the advantages and disadvantages of a premed committee can balance each other out.Medical school admissions is incredibly nuanced and tricky, and I've just barely given the tiniest example of its complexities. But first and foremost? Ignore the acceptance-rate stats. They are meaningless.CM’s Top 10 Universities for Pre-Med Students - College MagazineBy Alyssa Aguero |March 21, 2016As exciting (and scandalous) as Grey’s Anatomy may be, becoming a doctor is no walk in the park. But before you even begin thinking about what medical schoolyou want to go to, you’ll have to survive undergrad first. While pre-med isn’t exactly a major, many universities offer a track that’ll prepare you for med school. Pre-med clubs, shadowing opportunities and special programs should be considered when you’re deciding how you want to begin your medical career. College Magazine took some of the load off your shoulders (you guys have a lot of work ahead of you) and ranked the top universities for pre-med students.1. UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILLNinety percent of UNC’s students who apply to medical school get in…let that sink in for a second. One of this university’s gems is their 9-week Medical Education Development (MED) summer program. This rigorous program allows students to shadow physicians and participate in lectures and seminars for professional development. MED also mirrors a first-year medical student curriculum—it’s like getting a little taste of med school. Although there is no specific pre-med track at UNC, these students still receive a lot of guidance. “I think that the way all pre-med students, regardless of their declared majors, are accommodated and assisted throughout the process is [unique],” said Danielle Jamieson, a psychology and Hispanic linguistics senior.2. GEORGE WASHINGTON UNIVERSITYThe pre-med students at GWU aren’t limited to studying within the U.S. The university offers a study abroad program in the United Kingdom where students are given the option to either study at Kings College University of London or Oxford University. GWU also offers an all-in-one program where students can earn their bachelor’s degree and medical degree. However, this is a selective program. Only students who have demonstrated leadership and academic excellence, and have healthcare experience are permitted in this program. These lucky students get their MCAT waived and are admitted into GWU’s Medical School at a fixed tuition (big emphasis on lucky students).GWU offers an all in one program that leads to BA/MD. Program is based on academic excellence, healthcare experience, community service and demonstrated leadership. Incoming freshman are admitted into George Washington Medical at a fixed tuition rate; MCAT is waived.3. HARVARD UNIVERSITYEver wish you had a mentor who was also a doctor and always available for you? Well, Harvard does for their pre-med students. “At Harvard, we have three separate pre-medical advisers, one of whom is a doctor, available at any time, in addition to a pre-medical advisor who lives in the same dorm as you once you get to sophomore year, which is not common at other colleges,” said Bryan Peaker, a freshman studying human developmental and regenerative biology. And the advising doesn’t stop there. Harvard has a handbook for students on the pre-med track that tells them what classes they need to take, when to take them and how to get into medical school.4. BOSTON UNIVERSITYRemember when Charlie got a golden ticket to get into Willy Wonka’s Chocolate Factory? This is a similar case for the students at BU, except instead of a chocolate factory it’s med school. With their Early Assurance Program, students are guaranteed a ticket (provisional admission) into BU’s Medical School. This university also offers a duel liberal arts and medical degree path that gives students the chance to earn both their Bachelor of Arts and medical degree in seven years, as apposed to eight. To get into their accelerated program (different from the early assurance one) you need to complete the SAT or ACT plus Writing and SAT Subject Tests in Chemistry Math 2 and, if you’re feeling brave, Foreign Language. This place keeps sounding more and more like a chocolate factory.5. GEORGETOWNImagine finding out you got into medical school during your sophomore year of college—that’s what we call a stress reliever. The pre-med students at Georgetown get this privilege with the university’s Early Assurance Program. This program is for students who want to attend Georgetown’s School of Medicine and have excelled in their studies and have completed four semesters and classes in biology, chemistry, organic chemistry. These brainiacs can apply at the end of their sophomore year if they have completed four semesters at Georgetown and have taken four pre-med courses. Another plus from this program is that the students’ MCAT is waived. Georgetown also has a few pre-med clubs like the Pre-Medical Society and the Pre-Dental Society. The Pre-Medical society not only provides advising for pre-med students, but also sponsors mock interviews and brings in guest speakers from the medical field to talk to the student members.Georgetown allows undergraduate students to gain the training needed to meet medical school criteria; program is part of the degree curriculum. A Post-Baccalaureate Pre-Medical program is also available for bachelor degree holders who lack core Pre-Med Science courses.6. JOHNS HOPKINS UNIVERSITYSome say the best learning happens outside of the classroom, and that’s the case at Johns Hopkins University. Occasionally the professors let their students into their labs for research. The students here can get even more outside learning by taking a 15-minute shuttle ride to Johns Hopkins Medical Institute, where they can shadow doctors and conduct research. With all these opportunities, the pre-med students here don’t feel the need to compete with each other. “As undergrads, we encourage and assist each other in all of our coursework. [It’s] definitely not a cut-throat, competitive environment like some say,” said George Bugarinovic, a public health and natural sciences senior.JHU offers a Post-Baccalaureate Pre-Med program for all medical specializations. Program is offered on the undergraduate campus, School of Medicine and at the School of Public Health; students are able to carve out their own area of study.7. UNIVERSITY OF PENNSYLVANIAIf you’re in no rush to start med school, you’ve stumbled upon the perfect university. U Penn doesn’t believe in giving their pre-med students a fast track path into medical school. They want their students to complete their degree in four years so they can take additional classes that will make them more prepared for med school and beyond. U Penn is also located near several large medical institutes, like the Pennsylvania Hospital, which provide them with opportunities to shadow doctors and volunteer at hospitals. Clearly, this university knows what it’s doing since 76 percent of U Penn students get into medical school.U Penn offers a few Post Baccalaureate programs, two are relevant to the study of medicine; these include the Pre Health Core Studies and the Pre Health Specialized Studies. Both programs are very selective and pave way for further medical studies.8. UNIVERSITY OF WASHINGTONAs one of the top medical schools in the nation, it’s no surprise that the University of Washington has one of the best pre-med tracks in the nation as well. With a large number of premedical clubs (Alpha Epsilon Delta is a big one) and numerous shadowing opportunities, these students will be wearing white coats in no time. “The shadowing opportunities and your ability to get into research your freshman year is unreal, it’s [one] you can’t get everywhere. My winter quarter of my freshman year I got to shadow a mitral valve replacement [surgeon],” said Alec Sullivan, a competitive history of ideas sophomore.9. CORNELL UNIVERSITYHere’s a shocker: another Ivy landed on our list. With its two-year pre-med track program, Cornell prepares students by offering courses—introductory biology and chemistry courses to name a few—on sciences that are related to medicine. Students also have the chance to volunteer at the Cayuga Medical Center—a non-profit hospital right by the university. One of Cornell’s greatest resources is their PATCH club—a student-run organization that brings together pre-med and pre-health students. PATCH welcomes all pre-health students and offers a supportive environment and beneficial opportunities for its members such as bringing in guest speakers to talk about their experience in the health care field.10. NORTHWESTERN UNIVERSITYThe pre-med track is not an easy one, and Northwestern University gets that. Its pre-med peer mentor program (NU PPMP) selects upperclassmen with a strong academic standing to guide and support underclassmen on the pre-med track. This university is also big on research. Students are allowed to conduct their own independent study.“I joined a lab for two years and was able to take a really active role in research and actually got a Nature publication out of my time there,” said Jane Wang, biology major and 2014 graduate.NWU offers study abroad programs in the United Kingdom; students may elect to study at Kings College University of London or Oxford University. A Post-Baccalaureate Certificate is also offered to those hoping to complete the course work required for medical school.Top Premed CollegesBy Joe ThomasTop premed colleges can be ranked several ways, but the title of best academic program is indicative of the overall quality of medical students that a premed college produces. There are several ways to rank top premed colleges, such as MCAT and GPA, United States Medical Licensing Examination (USMLE) scores or applications received, but the fact remains that you should find a school that is a good fit for your personality and in a location you would enjoy attending. Some feel that for many students, their success, or lack of it, might be largely unrelated to the individual medical school.Using Student Scores and GPAWhen you consider MCAT scores that are greater than 31.5 and GPAs of greater than 3.5, the list gets narrower and can give you a better indication of competitive med schools that turn out the highest achievers and therefore, get more prestigious academic acknowledgement. The average USMLE scores are better statistics to consider than USMLE pass rates, but med schools don't publish board scores for confidentiality reasons. There are some premed colleges that have high pass rates, but lower average USMLE scores. It is a combination of several factors that make up the top premed colleges on this listing of colleges.The Ten Top Premed Colleges by MCAT and GPAWashington University St. Louis: 1 Children's Place, #4S20, St. Louis, Missouri 63110, Phone (314) 454-6120, http://www.medschool.wustl.eduHarvard Medical School: 25 Shattuck Street, Boston, Massachusetts 02115, Phone (617) 432-1000, http://www.hms.harvard.edu/hmsJohn Hopkins University School of Medicine: 733 N. Broadway, Baltimore, Maryland 21205, Phone (410) 955-5000, Home | Johns Hopkins UniversityVanderbilt School of Medicine: 215 Light Hall, Nashville, Tennessee 37232, Phone (615) 322-2145 Vanderbilt University School of MedicineYale School of Medicine: 333 Cedar Street, New Haven, Connecticut, 06510, Phone (203-785-2696), Yale School of MedicineDuke University School of Medicine: DUMC 3710, Durham, North Carolina 27710, Phone (919) 684-2985, Office of M.D. AdmissionsStanford School of Medicine: 300 Pasteur Drive, Stanford, California 94305, Phone (650) 723-4000, Stanford MedicineMayo Medical School: 200 First Street S.W., Rochester Minnesota 55905, Phone (507) 284-2316, Mayo ClinicNew York University: 550 First Avenue, New York, New York 10016, Phone (212) 263-7300, Education and TrainingUniversity of Pennsylvania: Suite 100, Stemmler Hall, Philadelphia, Pennsylvania 19104, Phone (215)898-8001, Perelman School of Medicine at the University of PennsylvaniaRankings of Premed Colleges by Student ApplicationsThe number of student applications gives an indication of the most popular choices made by premed students, but a larger portion of students will not be admitted due to admissions limits. Harvard and Stanford also make this listing, but the other eight choices are not in the top ten that are ranked by MCAT and GPA scores.University of California Los Angeles School of Medicine: 405 Hilgard Avenue, Los Angeles, California 90095, Phone (310) 825-4321, University of CaliforniaUniversity of California: 110 Sproul Hall, #5800, Berkeley, California 94720, Phone (510) 642-6000, University of California, BerkeleyUniversity of Michigan Medical School: 1301 Catherine Road, Ann Arbor, Michigan 48109, Phone (734) 763-9600, Michigan MedicineUniversity of Texas Medical School: 6431 Fannin Street, MSB G420 Houston, Texas, Phone (713) 500-5116, http://www.uth.tmc.eduUniversity of Florida Gainesville: P.O. Box 100235, Gainesville, Florida 32610, Phone (352) 273-7500, University of FloridaUniversity of California San Diego: 9500 Gilman Drive, LaJolla, CA 92093, Phone (858) 534-2230, University of California San DiegoHarvard School of Medicine: 25 Shattuck Street, Boston, Massachusetts 02115, Phone (617) 432-1000, http://www.hms.harvard.edu/hmsUniversity of Wisconsin Madison: 750 Highland Avenue, Madison, Wisconsin 53705, Phone (608) 265-6344, University of Wisconsin School of Medicine and Public HealthUniversity of Virginia School of Medicine: P.O. Box 800725, Charlottesville, Virginia 22908, Phone (434) 924-5571, UVA Health SystemUniversity of Illinois Medical School: 601 S. Morgan Street, Chicago, Illinois, Phone (312) 996-7000, http://ww.uic.eduStanford School of Medicine: 300 Pasteur Drive, Stanford, California 94305, Phone (650) 723-4000, Stanford MedicineChoosing a CollegeThere are many fine colleges for premed students and while some names are more recognizable than others, there is a good selection in a variety of regions across the country. The best advice when searching for the premed college choices that offer the best programs, is to find the ones that are best suited to all facets of your life and your medical education goals. Accredited colleges offer similar basic programs, but some might offer more specialized courses that are tailored to different healthcare fields. This is a consideration that most premed students use when determining the best premed college to meet their medical career goals.Best Universities for Pre-Med Students: List of Top SchoolsAlthough medical schools are often indifferent to an applicant's major, they usually look for prerequisite coursework in general and organic chemistry, biology, English, and physics. A strong undergraduate grade point average and competitive Medical College Admissions Test (MCAT) scores can also help students gain entry to a good medical or dental school. Some of the best universities for pre-med students include Harvard University, the University of North Carolina in Chapel Hill, and the University of Pennsylvania, all of which are highly ranked by U.S. News & World Report.Harvard University in Cambridge, MAHarvard University was ranked as the best medical research school for 2015 by U.S. News World Report. It is an Ivy League institution and has over a dozen groups for pre-med students, such as the Harvard Premedical Society, Harvard Hippocratic Society, and Latinos in Health Careers. The Office of Career Services provides pre-med planning for undergraduate students who want to apply to medical school upon graduation. Harvard also assists students in planning for careers in dental medicine, public health and advanced nursing.University of North Carolina in Chapel HillAs designated by U.S News & World Report in 2015, the University of North Carolina's medical program ranked second in primary care. Pre-med students get assistance from the Health Professions Advising Office in choosing programs and classes, applying to medical schools, and preparing for the MCAT. UNC also offers the Medical Education Development program (MED), a rigorous 9-week summer program for select students that mirrors a first-year medical school curriculum. Of the MED students who apply to medical school, 90% are accepted.The University of North Carolina has an active chapter of Alpha Epsilon Delta, the pre-professional health honor society.University of Pennsylvania in PhiladelphiaIn 2015, US News & World Report ranked the University of Pennsylvania eighth among national universities and fifth for medical research. A member of the Ivy League, this university offers advising and planning for undergraduate students preparing to attend allopathic or osteopathic medical schools. It also offers guidance for students interested in dental school. Through the College of Liberal and Professional Studies, Penn also provides a post-baccalaureate, pre-health program for students who have earned an undergraduate degree in a non-science major or who want to be better prepared for advanced medical study.The University is home to several medical research institutes studying Alzheimer's disease, cancer, and AIDS, as well as cardiovascular health, developmental biology, and head injuries.Top Schools for Pre-Med StudentsLet's take a look at some of the other top schools for pre-med students.Columbia University in New York, NY provides a comprehensive pre-medical handbook for students planning a pre-med curriculum. Columbia University offers a Post-Bachelor Premedical program that is considered the oldest and largest in the United States. Students from the program make up 90% of placement in American medical programs; program provides linkage to Columbia University College of Physicians and Surgeons.Cornell University in Ithaca, NY was named 11th best university in the world by the Center for World University Rankings.Johns Hopkins University encourages students to take a year off between undergraduate and medical school to gain additional experiences or conduct research. The school is located in Baltimore, MD.Northwestern University, located in Evanston, IL, has an undergraduate research grants program that provides pre-med students with funding to conduct independent research.The University of Minnesota - Twin Cities in Minneapolis, MN offers an online interactive workshop for students called Planning for Medical School.The University of Washington in Seattle, WA has an online guide to help students prepare for medical school admissions.The University of Wisconsin - Madison advises students wishing to pursue studies in physical or occupational therapy, pharmacology, physician assistance, and nursing in addition to medicine and dentistry.The best university for pre-med studies really depends on what you want from a school, because each of the top-ranked schools has unique aspects that help to make it one of the best.Colleges That Produce the Most DoctorsBy Nick Selbe on September 24, 2015In the coming months, pre-med undergraduates at colleges across the country will be preparing to apply for medical school.But where are most of the medical school applications coming from? StartClass set out to find which undergraduate schools produce the most medical school applications.The data comes from the Association of American Medical Colleges. The AAMC notes that the data is for informational purposes only and should not be interpreted as an assessment of an institution's pre-medical educational or advisory programs.Another caveat for this list is that schools with larger overall student bodies will obviously have more medical school applicants than smaller schools. Though the list is not a ranking of the best premedical schools, it is helpful to know which schools have the most aspiring doctors.#1 UCLA (919)#2 Michigan (825)#3 UC Berkeley (769)#4 UF (760)#5 UT Austin#6 UCSD#7 Cornell (509)#8 U Georgia (481)#9 Ohio State (473)#10 U Wisconsin - Madison (456)#11 BYU (450)#12 UIUC (427)#13 UC Davis (427)#14 U Washington (417)# 15 Texas A&M (411)#16 UNC (394)#17 JHU (390)#18 Duke (387)# 19 Emory (386)# 20 Rutgers (385)#21 UVA (368)#22 U Maryland - College Park (365)#23 Wash U (354)#24 U Arizona (353)#25 U Miami (348)#26 U Notre Dame (344)#27 Michigan State (343)#28 NYU (339)#28 U Penn (339)#30 Harvard (323)Pre-Med Choice of Undergraduate College Does Affect Med School Chances: What to ConsiderPosted on January 27, 2017 by Cheryl — 22 Comments ↓(Updated 2016) Some maintain that it doesn’t matter which undergraduate college you go to, as long as you get a top GPA and MCAT score. That’s wishful thinking. While high numbers are essential no matter where you go, once med schools look beyond their MCAT/GPA cut-offs, their decisions are impacted by where you attend undergraduate college, just as residency decisions are affected by which med school you attend. It’s not so much the school’s name, but the resources that it offers, that make the choice of undergraduate college so essential.This post is a long one because there are many things to consider. So, get comfy and read on.Look Closer When You’re Pre-MedPre-meds have to consider more than the basic college selection criteria — a good fit socially, the right size, talented professors, a decent location, etc. A pre-med also needs tools and opportunities that the average college undergraduate doesn’t, such as chances for research and publication, guidance from a knowledgeable pre-med adviser and, if possible, a letter of evaluation from a pre-med advisory committee. In fact, my son, AC, was so convinced the undergraduate college mattered, that he decided to transfer from his good, solid state university to a more pre-med focused university. That new college had the resources to better prepare him for the demanding medical specialty and top research med schools he hoped to (and eventually did) attend. Here’s what he considered:History of Med School Admissions. Even as a freshman, AC had an idea of what specialty he wanted to get into, and which med schools would help him get there. But after doing research, including discussions with his college advisers and professors, and Internet searches on class profiles for various med schools, he found that almost no one from his college had gone to those schools. It could have been that no one from his college had applied – that wouldn’t have been surprising considering how few pre-meds were on campus. Or, it could have been that those from his college who had applied had not gotten in. Either way, that lack of a connection between his undergraduate college and his target med schools was a concern. Such history, or lack of it, is one factor to look at in considering an undergraduate college.2008.11.25 – The physician by Adrian Clark (Flickr Creative Commons)Availability of a Comprehensive Pre-Med Advisory Committee Program. While many undergraduate colleges do not have pre-med advisory committees, there is a significant benefit to those that do. An established pre-med committee program offers expert advice and guidance as to course selection, application development, and application processing throughout the undergraduate years. An experienced pre-med adviser will protect you from rooky mistakes such as taking your organic chem classes during the summer (most med schools don’t like that) or assuming your high school AP chemistry credits will satisfy the pre-med chemistry requirement (it probably won’t).Most valuable are those committees that provide a committee letter of evaluation, which med schools prefer over only individual recommendation letters. The pre-med committee letter is given after the student provides information on his activities and research, sometimes a draft of his med school essay, and even a med school style interview with one or more committee members or other faculty. Some medical schools have relationships with certain pre-med committees, which could make a great letter from one of those committees have greater weight. Overall, an experienced pre-med committee can be invaluable, and whether your potential undergraduate college has one is an important consideration.Availability of Pre-Med Living-Learning Communities. Some colleges offer pre-med living-learning communities, much like honors communities, where pre-meds are grouped together in dorms and offered medicine-related programs. AC’s first undergraduate college did have one, and it was one of the most valuable aspects of his freshman year there. Although it had just a handful of pre-med students, the learning community offered AC exposure to other pre-meds and health professionals, presentations about and by some med schools, and community service or clinical opportunities.Pre-Med Honor Societies.. Alpha Epsilon Delta is the national honor society for pre-meds. Check to see whether your prospective college has a chapter. AC was a member of a chapter in his freshman year, and found it helpful both in meeting more pre-meds and in planning events of interest to aspiring physicians. Just be careful not to spend too much time attending meetings that won’t necessarily advance your goal to become a doctor. While groups like this can have value, especially for people who aren’t positive they want to commit to medicine, if you must choose between going to a meeting and taking part in another meaningful activity that you love, choose what you love. Being passionate about something is attractive to med schools, which seek students who will become passionate doctors.National Eye Institute : Documenting Research Findings (Flickr Creative Commons)Availability of Research Opportunities. Pre-meds, especially those planning on a research (as opposed to a primary care) medical school, need some type of research experience, preferably in an area that relates to medicine. Undergraduate schools with significant research money and a willingness to get their students into research early on, are much more valuable to such pre-meds than colleges with only small pots of research money.Potential for Publication. In addition to research opportunities, a pre-med planning on attending a research medical school benefits from a chance to publish. Generally, universities with significant research money have more publication opportunities than universities that aren’t heavy on research funding.Availability of Clinical Experience. Pre-meds, especially those interested in primary care, need opportunities to get clinical experience. Colleges with nearby hospitals or clinics could offer that potential.Rigor of the Curriculum. Top med schools often list a rigorous curriculum as a selection factor. When looking at colleges, ask these questions: Are the hard science courses strong enough that they will help prepare you for the MCAT? Are high-level science courses such as genetics or neuroscience offered? (Small, humanities-focused liberal arts colleges may not offer them.) Is the college recognized by inclusion in chapters of highly selective honor societies? Does it actively promote and advance its students to become scholars for exclusive programs such as the Fulbright or Goldwater? Med school committee members, like everyone else, are impressed with those types of honors. Does your potential undergraduate college nurture them?I can’t read a word of this essay of yours. Excellent WorkOther Considerations. There are plenty of people who want to chime in on which universities are the best for pre-meds. Online Colleges, Schools, Universities and Scholarships reviews by America edu - compiled a list of its “Top 20 Pre-Med Schools in America.” College Magazine published a Top 10 list in its 2015 “CM’s Top 10 Universities for Pre-Med Students.” And there are endless discussions about which are the best pre-med schools on forums such as College Confidential.But there are many very personal questions you need to answer before choosing your school. For example, becoming immersed in a predominantly and aggressively pre-med culture could narrow and skew your view of the world. How would that impact you as a person and an aspiring doctor? Also, the top pre-med colleges sometimes have a very competitive, almost cutthroat atmosphere, and some schools are very harsh in their grading. Will you will be able to thrive and pull the top grades you need from such a college? Consider seriously that your plans to be a doctor could end if you can’t get the grades you need for med school acceptance from that top pre-med college. You must know yourself well when choosing your pre-med college, just as you must in making the decision to pursue a career in medicine.Interview Groups told AC the Real Story: Your Undergrad College MattersGotCredit: College (Flickr Creative Commons)There are numerous debates on whether the undergraduate college you choose is important to your success with getting into med school. Some people charge that it’s all about “name dropping,” and that private schools perpetuate the myth that their degrees hold more value than less expensive public universities. The subject has been hotly debated in the college and student doctor forums. For example, see The Student Doctor Network’s “The Effect of Undergrad School on Med School Acceptance,” and “Theory: Admissions at Medical School DO Care Where You Went to Undergrad,” and Student Doc’s “Does Undergrad Prestige Carry Any Weight in Admissions?”But for AC, the tale was told when he did his interviews at a half-dozen of the best med schools in the country, and found one similarity: “I was meeting kids from the same schools over and over. They were from the Ivys, the public Ivys, and other top, very selective undergraduate colleges. I almost never met applicants from regular state schools. I know this isn’t a scientific way to make the conclusion, and I know so many of the best doctors and minds come from state schools and community colleges, but what I saw repeatedly in my interviews convinced me that coming from a top-ranked university with a lot of resources seemed to be a prerequisite for interviews at the top med schools.”Maximize the Resources of Your CollegeCollege Gameday by Phil Roeder (Flickr Creative Commons)All of this advice is valid and (I hope) valuable. But the reality is, circumstances (money, grades, scores, personal obligations, simply personal preference) may dictate you attend a college that doesn’t have a big pre-med focus. Yet, that does not mean you won’t have a chance of attending a good — or even a top — medical school. The most important way to make it to med school is to be knowledgeable and fully prepared for the journey ahead. Read all you can about different med school programs, what the schools are looking for, how to prepare for the MCAT test, even the possibility of doing a post-baccalaureate program if needed to boost your preparation for med school. Figure out how to get that clinical experience, research, community service, and leadership background that will prepare you for medicine.Learn about any and all activities your undergraduate school does have for pre-meds, and take full advantage of them. Even if it doesn’t have a pre-med advisory committee, it may have a pre-professional honor society such as Alpha Epsilon Delta. If your school’s chapter isn’t very active, join it and lead it into new and more productive directions. If there is no chapter, look into starting one, or check on whether there are chapters at nearby colleges.No honor society chapter? Start a less formal pre-med club to bring in speakers and doctors for education and possible mentoring. How to do that? Check with your school’s student activities office about the process for starting a club. Then talk to one of your professors, perhaps one that teaches a pre-med course such as biology or organic chemistry, about being your club adviser. AC was able to start an organic chemistry club at his school. It took a couple months to figure out the process, find an adviser, and then organize and publicize meetings, but the school was supportive and it eventually did happen. Your college wants you to succeed because it makes it look good, too, so let it know what you need, and ask for help.Aggressively look for a mentor who can guide you and, when the time comes to file your application, can speak personally about the qualities you have that will make you a good doctor. If you want to end up at a good med school, search out your college pre-med adviser early on, and talk about your goals. Ask for ways to help prepare you for what will be ahead as a pre-med, a med school applicant, and a med student. If your adviser is not very knowledgeable about med school preparation and the application process, ask him who is. Have him direct you to other possible resources, such as a local doctor who might take you as an intern. Or, talk to your university health clinic about letting you shadow its doctors. And, do your research on what is needed for a competitive application, then work hard to get the experience that will make you stand out in the crowd.Finally, keep in mind that, in some ways, being at a less pre-med focused university or a smaller college can have benefits, because you are more likely to stand out among your peers. You also may end up with much closer personal relationships with your professors, who will want to help you meet your high goals, and promote you in every way they can.The key is to be a knowledgeable self-starter, to ask for help and opportunities, and then to run with them. In fact, that is an essential characteristic for being a good doctor, so you might as well start building it now.TEDx GeorgeMasonU:George Mason University’s First TEDx Conference (Flickr Creative Commons)Parental Assist: Of course, there is the normal preparation needed for any kid considering colleges — take him to the schools to check them out, consider the big issues like location, costs, etc. Urge him to see whether there are any admissions talks specifically for pre-meds, and to attend them with questions ready to ask. Suggest he focus on issues such as med school admissions information, strength of any med school advisory committee, whether the committee does letters of evaluation, etc. Ask if he has specific med schools in mind yet, and offer to help research information such as med school admissions data for those schools. You could also offer to create files for each school, and/or charts to facilitate comparisons. But remember to also gauge how much your student is invested in these preparations. You should be a helpmate, not the driving force. If he isn’t interested in doing prep work himself, he probably is not ready to embrace a medical career.If it’s clear your kid is committed to pre-med, but won’t be going to a great pre-med school, be sure he understands that does not mean he will lose his dream of getting into a good or even a top med school, and becoming an excellent doctor. Plenty of exceptional doctors have come out of lesser- known undergraduate schools. It’s all about working hard to accomplish the goal.Top 20 Pre-Med Schools in America - Education AmericaMarch 8, 2011Top 20 CollegesTop 20 Pre Med Schools in America, listed by School, Average Verbal MCAT Score, Average Physical Science MCAT Score, Average Biological MCAT Science Score and Average GPA (unraked).Ø Cornell University offers a two year Pre Med track; program prepares students for entry into the four year medical degree program. Course focuses on sciences that are related to medicine; no degree is awarded.Ø Creighton University offers a 4 or 5 year Pre Med Nursing Track; a bachelor’s is awarded in both programs. A Post-Baccalaureate is also administered through the School Of Medicine; program prepares students intensively for medical school.Ø Boston University offers a Pre-Medical program in Pre-Dentistry, Pre-Medicine and Pre Veterinary Medicine, program allows students to create specific areas of study; a post baccalaureate certificate program is also offered.Ø Dartmouth Medical School offers a pre-med program in conjunction with Dartmouth College, an arrangement also exists between Dartmouth Hitchcock Medical Center (DHMC) and Dartmouth College. Health professionals advise and help students applying to medical, veterinarian and medical schools.Ø East Tennessee State University (J.H. Quillen) prepares students for the 4 year Doctor of Medicine degree through its Pre-Medicine Program. Students must complete courses required by most medical schools; these include Biology, General Chemistry, Organic Chemistry, Physics, English and Communication.Ø Baylor University provides a Pre-Med curriculum that emphasizes all areas of course work; medical pre-professionals are recommended to take Biology Chemistry, English, Mathematics and Physics.Ø George Washington University offers an all in one program that leads to BA/MD. Program is based on academic excellence, healthcare experience, community service and demonstrated leadership. Incoming freshman are admitted into George Washington Medical at a fixed tuition rate; MCAT is waived.Ø John Hopkins offers a Post-Baccalaureate Pre-Med program for all medical specializations. Program is offered on the undergraduate campus, School of Medicine and at the School of Public Health; students are able to carve out their own area of study.Ø Georgetown allows undergraduate students to gain the training needed to meet medical school criteria; program is part of the degree curriculum. A Post-Baccalaureate Pre-Medical program is also available for bachelor degree holders who lack core Pre-Med Science courses.Ø Saint Louis University’s 4 year Pre-Medical curriculum provides a foundation in the courses required for med school. Courses include Biology, Chemistry Physics and Calculus; program allows students to complete courses across disciplines.Ø Mount Sinai School of Medicine administers a Humanities and Medicine Early Acceptance Program, program was designed to prepare students for medical school. The 8 week summer program includes studies in Physics & Organic Chemistry, as well as other health disciplines.Ø Northwestern University offers study abroad programs in the United Kingdom; students may elect to study at Kings College University of London or Oxford University. A Post-Baccalaureate Certificate is also offered to those hoping to complete the course work required for medical school.Ø Ranked as one the Best Medical Schools (US News), Ohio State’s School of Allied Medical Professions Division of Medical Technology offers a Medical Science Track that leads to a BS in Science. Program was designed for pre-pharmacy, pre-dental, pre-vet and pre med students.Ø Howard University offers a dual degree in BS/MD; program allows students to earn both degrees in six years. Program makes an easy transition from undergraduate to graduate study; an overall G.P.A of 3.5 and an MCAT score of 24 must be satisfied. Students must also meet the minimum G.P.A of 3.25 in science.Ø Temple University offers two tracks of study for students who intend to study medicine, tracks include BCMS and ACMS. BCMS-Basic Core in Medical Sciences Program was designed for those lacking the core requirements needed for medical school. ACMS is for students who wish to enhance their credentials so as to pursue a career in medicine.Ø University of Iowa administers a Pre-Medicine track that includes math, chemistry, biology and physics. Students must declare a major in a specific area, program has led to high medical school acceptance rates.Ø University of Miami offers a Pre Law Undergraduate Program as well as a Post Baccalaureate Program; the Post Baccalaureate Program helps bachelor degree holders who feel they need more preparation prior to applying to law school.Ø University of Pennsylvania offers a few Post Baccalaureate programs, two are relevant to the study of medicine; these include the Pre Health Core Studies and the Pre Health Specialized Studies. Both programs are very selective and pave way for further medical studies.Ø University of South Florida offers programs to help prepare students for professional schools of medicine, dentistry, optometry, pharmacy, and many other health related fields. Students must choose another major besides the pre-professional requirement.Ø Columbia University offers a Post-Bachelor Premedical program that is considered the oldest and largest in the United States. Students from the program make up 90% of placement in American medical programs; program provides linkage to Columbia University College of Physicians and Surgeons.

Q. What is the difference between an ophthalmologist (MD) and an optometrist (OD) with surgery residency?A. Opposing views regarding expanding the scope of practice of optometrists to include surgical procedures.First by North Carolina Medical Society in opposition, citing:Extensive training ophthalmologists receive during their 3- to 5-year residency and fellowship programs after completing medical school including performing hundreds of surgical procedures on patients under the supervision of an experienced ophthalmologist.No such thing as “minor surgery “.JAMA study revealed a higher rate of re-operations for surgeries performed by optometrists.Second by Optometric Organization in support, citing success in laser surgery in OK and KY.Optometrists Seek to Perform Surgery (North Carolina Medical Society)UPDATE: 4-27-17: Study BillThis bill was introduced as a proposed committee substitute in the House Health Committee. The proposed committee substitute would direct the Institute of Medicine to study this issue, and report their findings back to the General Assembly in October 2018.The referrals to the House Insurance and House Appropriations have been stricken.This bill was heard on the House floor on April 27, 2017. This bill passed second reading with a vote of 109-6, and will now move to the Senate.UPDATE: 3-1-17: Both supporters and opponents testify before House Health CommitteeToday the NC House Health Committee had an informational hearing to learn about HB 36 from the optometrists who support the expansion of their scope of practice as well as those, like the NCMS and the NCSEPS, who oppose the bill.One of the primary sponsors of the bill, Rep. Justin Burr (R-Stanly) began the session claiming that HB36 would enhance access to eye care especially in rural areas of the state. He downplayed the difficulty of the surgical procedures allowed in the bill, stating they would be minor, level 1, surgeries. Two optometrists then testified that:Optometrists would receive “vigorous training” in these new procedures. However, when asked by Donna McDowell White (R-Johnston) about what the Board of Optometry envisioned as the credentialing process to perform the surgeries, the President of the Optometry Board, H. Mike Johnson, OD, only said it would be ‘proper’ education, training and experience.A Charlotte area ophthalmologist, Galen Grayson, MD, told the committee he supported the bill as long as optometrists had “proper training and certification.”An optometrist from Oklahoma, where optometrists have been allowed to perform such procedures since 1996, testified there have been no complaints and malpractice rates have remained low. Greg Murphy, MD (R-Pitt), pointed out that malpractice cases are an indicator of negligence, not quality of care. Complication rates and the necessity to operate again to correct mistakes in the initial procedure are better measures of quality. He referenced a JAMA study that revealed a higher rate of re-operations for surgeries performed by optometrists.Dr. Paul Cunningham testifies before the NC House Health Committee.Speaking in opposition to the proposal were Susan Burden, MD, an Associate Professor of Ophthalmology at Wake Forest University, Paul R.G. Cunningham, MD, NCMS president and Tom Fetzer, a lobbyist for the NCSEPS, who shared his personal story of eye surgery to illustrate the gravity of any procedure performed on or around the eye.Dr. Burden highlighted the complexity of performing eye surgery, and the dire circumstances that result from missed diagnoses or poorly performed surgeries. She spoke about the extensive training ophthalmologists receive during their 3- to 5-year residency and fellowship programs after completing medical school including performing hundreds of surgical procedures on patients under the supervision of an experienced ophthalmologist. She noted that none of the VA facilities in the country allow optometrists to perform the procedures outlined in HB36.Dr. Cunningham reminded the committee members of their obligation to protect the citizens of the state. “There is no such thing as ‘minor surgery,’” he said. “The state has a compelling obligation to ensure the safety of its citizens. While I hold optometrists in high regard, patients need highly trained surgeons with the skills and dexterity gained through experience to perform surgery.”UPDATE 2-28-17:The House Health Committee is scheduled to meet this Wednesday, March 1, at 11:00 a.m. to discuss HB 36 – Enact Enhanced Access to Eye Care. No vote is expected at this committee meeting. Please voice your opposition to allowing optometrists to perform surgery through our Action Alert!HB 36 – Enact Enhanced Access to Eye Care ActPrimary Sponsors: Rep. Justin Burr (R- Stanly), Rep. Jeff Collins (R– Nash) , Rep. Josh Dobson (R – Avery) and Rep. Julia Howard (R- Davie).This bill seeks to expand optometrist’ scope of practice to include surgical procedures. As currently constructed, the bill does not define what optometrists are allowed to do because the bill only defines exclusions. As proposed, optometrists would be excluded from performing just 18 surgeries while having an unlimited scope related to all other surgeries not defined in the bill. NCMS opposes optometrists doing any surgery because we do not believe that optometrists have the necessary training and experience to practice laser surgery.The optometry scope of practice has changed significantly over the past twenty years. They have been allowed to prescribe pharmaceuticals and do some limited injections that relate to the primary care of the eye. Surgery is something completely different. Eye physicians and surgeons train for three years under close supervision after completing graduate medical training. Optometrist propose to receive any training they deem necessary through continuing education.Our patients deserve the best care from the most trained practitioner when it comes to surgery on the eye whether utilizing a laser or a scalpel. Optometrist perform a valuable function within the health care team but lack the necessary skills and training to be allowed to perform surgical procedures.Optometric surgical privileges improve access to care, ease financial burdensAlthough not all states share the same access-to-care needs, rural areas derive a clear benefit from such legislation.Primary Care Optometry News, January 2012I. Ben GaddieThe issue of whether optometrists should be permitted to perform surgical procedures is one that has generated a great deal of controversy, legislative debate and contention within the eye care profession.Currently, two states – Oklahoma and Kentucky – permit some degree of laser surgical privileges for optometrists. In 1998, Oklahoma became the first state to allow optometrists to perform some minor surgical procedures, including some procedures using a scalpel and lasers. In early 2011, Kentucky optometrists gained the authority to perform certain types of injections, laser procedures and “lump and bump” procedures around the eyelids.While many arguments have been articulated both for and against optometric surgical privileges, perhaps the most powerful case for such legislation can be conveyed simply through numbers.“There are 550 doctors of optometry in 106 of Kentucky’s 120 counties. In contrast, two-thirds of the state’s counties do not have an ophthalmologist,” I. Ben Gaddie, OD, president of the Kentucky Optometric Association and aPrimary Care Optometry NewsEditorial Board member, said in an interview. “And at the same time, patient need is increasing.”Defining ‘surgery’David A. CockrellAccording to David A. Cockrell, OD, FAAO, vice president of the Oklahoma Board of Examiners in Optometry and secretary-treasurer of the American Optometric Association, some of the minor procedures categorized legislatively as surgery would not fall into most people’s definitions of surgery.“We don’t get to define which procedures are listed as surgical procedures,” Dr. Cockrell told PCON. “Many of the procedures optometrists perform – from the simple removal of an eyelash to something much more broad – aren’t considered by the general public to be surgery.”Bobby J. Christensen, OD, FAAO, a private practitioner in Oklahoma, said most procedures performed by optometrists are minor, such as foreign body removal, draining a stye or epilating lashes.“It has been my experience over the last 30 years that optometrists will not attempt a procedure they do not feel qualified to perform, even if the law will allow it,” he said in an interview. “If the foreign body is embedded on the visual axis or has penetrated into the posterior stroma, the optometrist is going to refer that patient to the corneal specialist, just like most general ophthalmologists would do.”Bobby J. ChristensenDr. Cockrell pointed out that some newly developed technologies and procedures might be classified as surgeries, which would automatically exclude optometrists from performing them.“If optometrists don’t have surgical privileges and something new comes out – even if it’s something we’ve already done, but just a new technique – we have to go back each time and legislate for that specific technique,” he said. “No other health care profession has to do that.”Access issuesIn states such as Kentucky and Oklahoma, which encompass many remote areas, the issue of access to care has been a key consideration in seeking optometric surgical privileges. Dr. Gaddie said the legislation is expected to make care more available to Kentuckians.“This law will enable patients to visit their local eye doctor to undergo these procedures, instead of having to travel to an ophthalmologist – often in another city or county – for the same level of care,” he said. “Patients benefit by having greater and easier access to a wide range of eye care performed by the eye doctor they know and trust.”Dr. Cockrell added that the issue of access to care is not strictly geographical. He discussed two underemphasized access problems, the first of which is wait times for appointments.“In many busy surgical practices, it literally could be 1 to 2 months’ wait time for a surgical intervention, even for simple procedures,” he said, “as opposed to a quick appointment within a day or two. So it’s a timeliness issue.”The second issue Dr. Cockrell cited was access to insurance panels, another potential source of confusion.“Someone I refer to might not be on that patient’s panel, although I might be,” he said. “It then becomes a panel/provider issue, which can become complicated and expensive for the patient.”Economic considerationsFor patients with limited access to eye care, the option of seeing a nearby optometrist for minor surgery could decrease time away from work, thus reducing financial burdens.“In some areas, a patient might have to make a 3-hour trip to get a procedure that literally takes 10 to 15 minutes to perform,” Dr. Cockrell said. “They have to take a full day off from work to do this, which significantly increases the cost. If they can see a practitioner in their own community for the same procedure, their time away from work is considerably reduced.”Dr. Gaddie said optometric surgical privileges also help streamline the Medicaid process and cut costs.“Medicaid costs will be reduced, because eye care patients will need fewer referrals and fewer multiple office visits, and will incur lower transportation costs,” he said. “This is a much-needed savings for a program running a deficit in the hundreds of millions of dollars.”For practitioners, surgical privileges might decrease frustrations over billing codes, Dr. Christensen added.“Many of the minor procedures fall under the surgery codes,” he said. “The optometrist might not get paid for a simple epilation because of the billing code.”Impact on optometric educationAs optometrists in some states expand their practice scopes into surgical procedures, this expansion is likely to broaden the parameters of optometric education. According to Dr. Gaddie, most optometry students are already exposed to some extent of surgical training.“Most of the schools and colleges of optometry teach and train laser and minor surgical procedures already,” he said. “Any substantive scope-of-practice change in the profession of optometry has implications for optometric education.”‘Providing the latest and best’Dr. Cockrell said he believes optometry – and health care overall – is likely to benefit from the profession gaining surgical privileges.“I think this will have a positive effect on health care,” he said. “Health care is continually changing, and optometry still encompasses a broad range of services, from routine eye examinations to specialized vision therapy, to traumatic brain injury therapy. This enables our profession to spread out and do more.”Dr. Gaddie said the acquisition of surgical privileges is also likely to improve the eye care experience for patients.“We already comanage and treat a variety of complex conditions, as well as provide pre- and postoperative care for glaucoma, cataracts, complications from diabetes and other issues,” he said. “Now, doctors of optometry will be able to provide the latest and best technology to treat their patients in their office, rather than forcing them to make a second appointment to travel to another doctor.”He added that in light of health care reform, the need for such efficiency is likely to become greater than ever in his state.“Health care reform is expected to create an additional 600,000 newly insured Kentuckians who will need convenient access to quality eye care,” he said. – by Jennifer Byrne

Q. Is it worth it to join the American Medical Association as a family medicine doctor (or any kind of primary care physician)?IS THE AMA REALLY THE VOICE OF PHYSICIANS IN THE US?Jun 9, 2015 | Doctor's VoiceThe American Medical Association is all over the media as representing the voice of doctors. Even politicians cite AMA statistics in driving healthcare policy. But, the fact is, physicians disagree. We do not believe the AMA represents us in anything, and doctors left their memberships in large numbers. In fact, it is estimated that only 15-18% of doctors in the US are paying members of the AMA. In one study conducted by Jackson and Coker, only 11% of physicians who responded believe the AMA stand for the views of doctors.WHERE DID THE AMA GO ASTRAY ON THE PATH OF REPRESENTING PHYSICIANS?1. Perhaps the biggest example of how doctors lost their trust in the AMA is the way they are funded. With less than 20% of US doctors paying membership dues, it is apparent they secure funding from other sources. One of their biggest streams or revenue is their profits from selling billing coding, insurance, and other products. Most doctors disagree with the CPT-10 billing transformation. Yet, the AMA continues to profit hugely from selling these products despite our protests. Clearly, doctors’ opinions have been shoved under foot in their quest to drive profits.2. The AMA is very ineffective at lobbying. One of the greatest examples can be seen in the SGR debacle playing out over decades. They were unable to change or influence any policy change. In fact, doctors feel that they sided with the politicians more often that with practicing doctors. Again, we were not represented by the AMA here.3. Doctors feel abused by insurance company policies. Reimbursements have been shrinking and often we are fighting to get paid for services we have provided. Here too, the AMA has offered little help. This is perhaps one of the biggest factors driving doctors out of private practice. Yet, they stand mute on slowing down the flow of doctors out of their own practices.4. Mandates coming out of the government are intruding into the practice of medicine. The AMA does not hear doctors’ concerns here but rather stands for itself. They throw their weight behind the politicians they chose rather than the mass of physicians. We feel the AMA would sell us out in a heartbeat.5. The media often quotes the AMA as being the voice of doctors. Yet, less than 20% of physicians in our country are even members. When doctors see these things in the media, it further tears down our trust because we have not been asked where we stand on the issues. While, they are speaking up that they are representing us. No, they are not and the media and general public need to learn that the AMA no longer represents the majority of doctors in the US. Perhaps, it is time for them to investigate what they have done to drive doctors away.The healthcare landscape in the US is rapidly evolving. Many changes appeared that are harmful to our profession and patients alike. Doctors have no organization that truly represents what we are going through and none to drive truly beneficial reform. While doctors burn out from lack of guidance and enforced compliance with unreasonable mandates and guidelines driving insurance company profits, the AMA speaks out while ignoring our plight and our voices. The AMA is not the voice of doctors and it is time that people stop recognizing them as something other than a political organization shaping reforms and selling products off the backs of doctors for their own agendas and profits. Does anyone know an organization that is willing to stand up and be the real voice of doctors and help mold real healthcare reform?LIKE WHAT YOU’RE READING?Get Dr. Linda’s New Book! Inside Our Broken Healthcare SystemDr. Linda Girgis MD, FAAFP, is a family physician in South River, New Jersey. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. Over the course of her practice, Dr. Girgis has continued to earn awards and recognition from her peers and a variety of industry bodies, including: Patients’ Choice Award, 2011-2012, Compassionate Doctor Recognition, 2011-2012. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.Follow Dr. Linda Girgis, MD, FAAFP: Website | Twitter |'Like a slap in the face': Doctors no longer feel the nation's largest doctors group represents their interestsEven before the recent election, physicians felt perched on a precipice.Joe Raedle/Getty ImagesChanges sweeping health care have threatened their independence, income, and influence. An epidemic of burnout and depression shadows the profession. And the incoming Trump administration promises still more upheaval.Who represents doctors in this unsettling environment? Decades ago, the answer would have been clear: the American Medical Association, the nation's oldest and largest medical organization.But today, medicine is a house more divided than ever.The AMA still has more clout — and spends far more on lobbying — than the scores of medical specialty societies and splinter groups that sort doctors by political leanings. But it counts fewer than 25 percent of practicing physicians as members, down from 75 percent in the 1950s.And the association infuriated many doctors recently with its quick endorsement of President-elect Donald Trump's choice for secretary of health and human services — Representative Tom Price, an orthopedic surgeon-turned-congressman who's led the charge to overturn Obamacare. Just two weeks earlier, the AMA's House of Delegates had reaffirmed the association's support for coverage expansions under Obamacare."That felt like a slap in the face, and many physicians aren't sure if the organization really stands for us any longer," said Dr. Christian Pean, an orthopedic surgery resident at NYU Hospital for Joint Diseases and a 2014 recipient of the AMA Foundation's leadership award for young physicians.AP/Gerald HerbertDivisions within doctors' ranks could make it more difficult for their voices to be clearly heard in the coming clamor to replace the Affordable Care Act with a Republican alternative."Doctors are disorganized, and it's a shame because we seriously need physician leadership to inject some sort of moral authority into [this] debate," said Dr. Robert Berenson, a senior fellow at the Urban Institute and former high-ranking official with the Centers for Medicare and Medicaid Services."This is a real litmus test for the AMA," Berenson said. "Do they have the will and the fortitude to step up and oppose rolling back all the progress we have made, or will they be accommodating and quiescent?"A Trump pick roils the ranksJust hours after Trump named Price as his pick to head HHS, the AMA's board of trustees put out a strong statement of support.Controversy erupted immediately. Within days, more than 700 AMA members had signed a letter protesting that endorsement as "divisive." A separate petition accusing the AMA of disregarding patients' needs drew 5,500 physician signatures.Dr. Patrice Harris, board chair of the AMA, found herself in the hot seat.In a recent phone interview, Harris said the organization's endorsement of Price doesn't signal that the AMA has backed off its support for Obamacare. "Our commitment to health insurance coverage hasn't changed," she said. "Our commitment to the principles of the Affordable Care Act has not changed."A doctor examines a patient. Gerald Herbert/AP ImagesHer language puts the association on the record, but it's hardly the strong, clear public declaration that AMA members had requested at an association meeting last month in Orlando, Fla.At that meeting, just a few days after the election, physicians passionately debated Obamacare and ended up asking the AMA to publicly reaffirm its dedication to "comprehensive health reform" that "improves access to care for all patients."Harris was similarly cautious when asked about the AMA's support for family planning services, which Republicans have said they want to cut. "We remain committed to preventing intrusions into medical decisions that we strongly believed should be reserved for patients and physicians," she said.Asked about turning Medicaid into a block grant program, which Price has backed in the past, Harris said: "We don't find it productive to deal in hypotheticals."Instead, she noted that Price is a longtime AMA member and praised him for having been "accessible to us." Harris said he "seeks out and listens to physicians' concerns" and is "attuned, as a physician, to how policies impact delivery" of health care.Beyond that, Price's views align with AMA policies in several areas, including the need to fix problems with electronic health records, reduce regulation, and eliminate a deeply disliked method that Medicare has used to control physician spending."But there's also been times when we disagree," Harris said, adding that the endorsement does not "equate with an agreement on all his prior policy positions."Win McNamee/Getty Images'Followers rather than leaders'That kind of caution is characteristic of the AMA, which generally prefers to work behind the scenes and press its agenda at the negotiating table, rather than rally the public."They end up being followers rather than leaders because they want to be where the action is," said Dr. Marcia Angell, a former editor of the New England Journal of Medicine and a senior lecturer in the department of global health and social medicine at Harvard Medical School.More than 190 medical organizations with various agendas are represented through the AMA's House of Delegates, forcing the organization to balance often-competing interests. On top of that, there's growing political polarization among doctors, now split almost evenly between Republicans and Democrats. And clinicians are further divided by type of practice and employer.Because the AMA's tent is so large, "they have difficulty articulating strong policy positions," said Berenson, the Urban Institute scholar.Dr. Jeffrey Singer, a general surgeon associated with the libertarian Cato Institute, quit the AMA 15 years ago out of frustration with what he perceived as its timidity. He wanted the group to stand up more forcefully against government meddling in physicians' practices.But the AMA leadership "no longer wanted to make waves," Singer said. "I just didn't feel they represented me anymore."Donald Trump. APA top-dollar lobbying force, but declining cloutWealth has guaranteed the AMA influence in the corridors of power, nationally and in the states. The association has spent $347 million lobbying since 1998 — more than any other company or group except the US Chamber of Commerce and the National Association of Realtors, according to the Center for Responsive Politics.Still, scholars agree that the association's clout has declined over the last 30 years as specialty societies rose in prominence, health care costs soared, managed care became more prevalent, and physicians' allegiance to the organization diminished."Their influence over health policy eroded badly," Jonathan Oberlander, chair of the department of social medicine at the University of North Carolina, Chapel Hill, said by email.It's impossible to say how many practicing physicians belong to the AMA because the organization wouldn't say how many of its 234,360 members were medical students. But it's clear that just a fraction of 926,000 doctors practicing in the US pay AMA dues.Nonetheless, Harris said the association represents "90 percent of physicians in this country" through its House of Delegates — where every specialty medical society and state and country medical county casts votes on proposed policies.But others point to increased splintering within the profession, with left-leaning groups such as Doctors for America and the National Physicians Alliance and right-leaning groups such as Docs4PatientCare and the Benjamin Rush Institute now competing for doctors' loyalty.AP Photo/Charles DharapakA history of deep conservatismThroughout most of the 20th century, the AMA fiercely defended physicians' autonomy and opposed government involvement in health care, earning a reputation for deep conservatism.It opposed including health insurance in the Social Security Act of 1935.It fought President Harry Truman's national health insurance plan in the 1940s.It fought the creation of Medicare and Medicaid in the mid-1960s.Dr. David Blumenthal, a former US national coordinator for health information technology, remembers becoming passionate about improving patient access to care during the late 1960s and 1970s."I didn't think, at the time, the AMA was in the vanguard of these issues," said Blumenthal, 68, who has never joined the association. "To the contrary, it was very visible in its opposition."But in recent years, the AMA has been more aggressive about expanding access to health care, reducing the ranks of the uninsured, and addressing other social issues.Its embrace of the Affordable Care Act in 2009 was unprecedented, and deeply controversial. In 2014, it passed resolutions in support of transgender rights. And earlier this year, the AMA declared gun violence a public health crisis — and began lobbying for gun control measures.Patient Rose Bush (R) receives treatment from Doctor Leon Yeh in the Emergency Room at OSF Saint Francis Medical Center in Peoria, Illinois.REUTERS/Jim Young"They've softened around the edges," Blumenthal said.Such moves have won the AMA points with some socially conscious younger physicians, who have worked hard to advance policies the organization once would have shunned."I joined the AMA because I saw the ability to make a difference," said Dr. Laura Faye Gephart, a Texas obstetrician-gynecologist who has been a member since 2005. "A group of us are pushing hard to make the organization more responsive to issues we see affecting our patients' health."That group was dismayed by the Price endorsement, and Gephart was among the physicians who signed a petition asking the AMA to clearly articulate its support for Obamacare, family planning, gay marriage, and adequate funding for Medicaid.The association has yet to put out such a statement. And now, many are wondering if its voice will be muted in the public sphere in the coming debates over health care.That would be "unfortunate," said Beatrix Hoffman, a history professor at Northern Illinois University who studies the politics of health reform, "because people tend to trust physicians and want to hear from them."Bad Medicine: How The AMA Undermined Primary Care in America - Brian Klepper