medical school

Here are the 2 questions I ask any new patient to determine if they are crazy or not. It is sure-fire:

1. Do you have any allergies? (if they report they are allergic to more than 3 things or "every antibiotic", they are crazy)

2. Is there a history of mental illness in your family? (if no, IT'S THEM)

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

― USADA Bin Dopen (dayo), Tuesday, September 4, 2012 6:06 PM (1 minute ago) Bookmark Flag Post Permalink

well it could be if you're on the psychosis ward

BOOM

(just a bit of fun, etc)

xp ha, i like that kate78, and am totally stealing it, my EM attending will eat it up.

what's the earning potential like in psychiatry

depends entirely on beard length & style

I think Psych tends to be on the lower end of avg salary (which still means a median of like $150,000) because talking in general is really poorly reimbursed (which is why so much of talk therapy is done by Psy.Ds or paid privately, because otherwise it is sort of fiscally difficult to make your margins on 60 minute visits without procedures). But really the right answer is to do the thing you would do for a crappy salary (if your ginormo student loans were not an issue).

Also I am at a VA right now and it is my dream of dreams to set up a Med-Psych unit, because there are way too many dudes with significant comorbidities in one who come in with some acute problem of the other (e.g. schizophrenics with AKIs, people with metabolic syndrome issues that are prob associated with their atypical antipsychotics), and they go to medicine because Psych floors aren't equipped to do a lot of basic medical floor stuff, but the medical floor staff is also poorly equipped to deal with crazy dudes being all crazy, so they just snow them or restrain them or whatevs until their medical issue resolves. I basically babysat a dude for four days with an AKI he got because he wasn't eating because his medication was super-overkill and he just slept all day, and only after his Creatinine was acceptable could he go up to Psych for proper medication management. I just want a place where Psych people can manage the Psych issues and medicine people can manage the medicine issues and ideally they both learn from each other.

totally and this sort of speaks to the need to actually teach non-specialist HCPs to be confident with these disease states so these management/handoff problems aren't so pronounced - as i sort of alluded to earlier, mental health is too often seen as separate from ~health~; and as gbx and kate said, the relatively little enthusiasm w/ which practitioners-in-training approach their psych month (and the fact that most get ONLY a month; for us pharmacists it's not even a requirement during clinical year) leads to the fragmenting of care for these people who are often complicated, both mentally and physically. leads to wasting of time (and $$) and isn't best for patients

i know you are kind of joking but i know non-crazy people who are legit allergic, like throat-closing-up allergic, to more than 3 things
xp

tbh i have little sense of humour when it comes to the issue of mental illness/"crazy" as considered by the mainstream medical profession let alone general society. but i know doctors gotta joke... often morbidly...

:-/

gbx psych seems p awesome to me

Hey, good choice.

I like psych a lot, that's what I was leaning toward at first. Read a lot of psychology / Freud / etc in undergrad, loved it. Eventually opted for neuro b/c I like the anatomy and (potential) precision. Also I found the worst-affected psych patients were too crazy to have much of a conversation with (this was no doubt influenced by the fact that my clerkship rotation was on a locked inpatient ward). In the other non-procedural and talky parts of medicine (neuro, geriatrics, GIM...) you meet all sorts of people with mental health issues (as you well know) but more of them are more normal, and more reachable in conversation, which gives me a chance to connect/persuade in the clinical half hour.

Have you read Tanya Luhrmann's "Of Two Minds"? She's an anthropologist, spent a couple of years training as a psych resident ca. the late 90s, at the cusp of the SSRI / atypicals sweeping in and marginalizing psychotherapy. My main interest was psychotherapy, and I saw the same trend, which was another strike against psych for me.

I still love psych cases. My main interest in neuro is non-neurological neurology: pseudoseizures, psychogenic movement disorders, functional weakness, and subjective symptoms without underlying pathology (this is a huge category, includes migraine and all its many branches). My most involving cases almost all have a psych flavour. They're often very frustrating, because the psych situation presents with neuro phenomenology and usually resists treatment from either end, but I love them nonetheless.

The point about multiple allergies is that they often correlate with a general sensitivity in the patient, who may be more likely to notice/report symptoms of any sort.

Very few of the allergies listed on medical charts are anaphylactic or otherwise medically significant. Most are intolerances or typical side effects (many people list allergies to morphine and other opioids because of sediation or delirium or even nausea/vomiting). Some are seemingly offered for secondary gain (patients who report anaphylactic reactions to all non-narcotic pain medications when presenting to ER with severe pain). A few suggest the patient's understanding of their health is not going to be easily mapped with my usual compass (the many people who tell me they are "allergic to toxins" or "sensitive to all medications").

(As a side note, a major goal of the move to electronic medical records and other forms of safety-conscious checklist medicine is to make sure that all allergies are recorded and reviewed at every encounter. This is a huge investment of time and energy in information that is usually dubious at best and of little or no clinical relevance in almost all cases.)

It's fairly well understood that there are neurological correlates for a state of central hypersensitization, which can apply to sensory symptoms of all sorts. Hypersensitive patients are more likely to experience and/or report severe headaches, chronic/recurring indigestion and abdominal pain, painful menstrual periods, aching muscles, tingling numbness, motion sickness or chronic dizziness, and allergies of all sorts. Most (but not all!) of those symptoms are not associated with significant underlying pathology, and therefore are given syndromic diagnoses like migraine, irritable bowel syndrome and fibromyalgia. As a neurologist I tend to think of all of this as being in the broadest sense migrainous -- related to dysfunction of otherwise intact neurological structures.

A patient with multiple allergies is more likely to present with (often, multiple) symptoms that will not be easily explained by objective tests. It is usually harder, in medicine, to prove that nothing serious is going on than to figure why something serious has gone wrong. Ambiguous symptoms can be time consuming and frustrating to assess in detail, especially if the (sometimes unfair!) expectation heading into the encounter is that there likely will be nothing to find. Many doctors/etc are impatient types and have a low tolerance for ambiguity. Thus the mordant (not morbid) humor.

Rules of thumb I have personally found useful:
-- A patient wearing sunglasses indoors will have a normal exam
-- A (non-pediatric) patient with a stuffed animal on the bed will have reassuring test results
-- A patient who comes to ER with a suitcase (one of mine last week brought 2 cardboard boxes of stuff, like she was moving into a dorm room!) may not necessarily need to be admitted after all

ah, what i was saying is that *i find* that sense of humour morbid (dark, disturbing, unhealthy) in that "crazy" is so often used as a dismissal rather than a window into further inquiry - sarcasm is one thing, but it's disturbing in that even if doctors in this thread (jokes are jokes i realize that) don't necessarily dismiss people's health concerns due to "crazy," many people do, doctors or otherwise. psych ward patients are one thing, of course, but it's worrying to me that docs would and do jump to "crazy" with people who have a referral to a specialist, who happen to present a few markers of mental instability or simply don't express themselves well in speech or can't focus their thoughts in a situation where an authority figure has (what the patient perceives to be) most of the power. or etc. I just think it's unfair that some doctors do at least initially paint people as normal or crazy, easy to deal with or overly sensitive/reactive, when there is such a broad spectrum in between. I would assume that psychiatry is more about examining that spectrum and breaking down the stigmatizing normal/crazy dichotomy.

It's definitely a spectrum / continuum, not a dichotomy. Didn't mean to imply otherwise. And certainly patients who seem difficult to doctors deserve the same high standard of care as everyone else. I don't dismiss their concerns, I spend a long time listening and document everything they tell me in detail.

It is a fact that doing so is tiring and more difficult than dealing with people who are more straightforward. That's one of the challenges of the job, I don't mean to whine about it. A major part of my job is seeing patients that other doctors find difficult to figure out for one reason or another.

I would guess that most other service industries make jokes and tell stories about demanding and difficult customers/clientele. Medical workers are not unique in this regard, but the fact that they're dealing with the health of their patients makes inappropriate joking that much more offensive, I agree.

sooo....surgery is awesome

(nb - we have a very strange 3/4 yrs here, where it is common not to get core rotations until your 4th year. like, i'm doing surgery now, and still have OB and the second half of internal medicine. its stupid.)

i'm in my first week at the Top Secret surgery-is-fun site (only 2 students, doesn't host a residency). first assist in pretty much anything you can get into (which is basically anything you want cuz, you know, only two students at a tertiary care hospital), all the attendings are ~really nice~ (friendly pimping, esp since there's no fellows or residents to embarrass you in front of), you only have to pre-round on patients you've scrubbed in for (and there's a lot of outpatient procedures...so, often it's zero to three ppl you have to see), formal rounding with students happens ONCE A WEEK (but it happens randomly, so you still need to be on the ball), call ONCE A WEEK (and you can choose the night...and call ends at 10pm!). we have also been assured that, by next week, we'll be "cutting," and that by the end of six weeks we'll be "doing surgery." i did a skin closure (sub-cuticular) on a open inguinal herniorrhaphy this morning (my third procedure of the clerkship), and i got to drive the camera during this afternoon's lap chole

oh and no weekends

http://gifsoup.com/webroot/animatedgifs4/1324222_o.gif

do you get to ride unicorns on yr lunchbreak y/n

no but the hospital IS connected by SKYWAY to a place that has a "global market" food court with a bunch of independently run shacks or w/e where you can get basically anything from african to vietnamese to middle eastern food.

also the hospital has a 24hr mcdonald's

in it, physically

if you're hi rn and making all of this up I'm going to be upset

I am intrigued to hear how it stands up to psych! I guess quite differently...

if you're hi rn and making all of this up I'm going to be upset

no way lady, real talk

then u are living the dream, my friend

I am intrigued to hear how it stands up to psych! I guess quite differently...

― obliquity of the ecliptic (rrrobyn), Thursday, September 27, 2012 7:04 PM (1 hour ago) Bookmark Flag Post Permalink

romulus and remus imo

i decided today that they are very similar in at least one respect: both have, at some point, and in some way, relied on tautological criteria for intervention. according to my psych attending, the diagnostic criteria for depression include (or included at one point, either in the DSM or by convention) the stipulation that the patient "responds to anti-depressants." whatever you say, doc.

similarly, some surgical procedures are diagnostic in and of themselves, and only justify the intervention retrospectively. "hmmm this guy sure seems like he has appendicitis, let's do an appy." *nope* "welp (~watches the Days Without Unnecessary Surgery counter roll back to 000~." *yup* "i knew it!"

i like to think of it this way: a guy's in clinic and an x-ray (let's say for lower back pain) turns up a square intra-abdominal object as an incidental finding. he is referred to a surgeon ("cmon the dude's got a thing in his belly!"). he evinces zero abdominal symptoms, per se, but the surgeon thinks, maybe, that he could have cats syndrome ("i mean, i know it doesn't seem like the ~classical~ presentation of cats syndrome, but what if it's an aberrant presentation?").

a procedure is performed.

the surgeon locates the object---a clasped metal box---and removes it from where it was seated under the liver. down in the path lab, the box is opened. the lab decides to adopt the kitten, naming it goljan. the surgeon receives a text page, "you were right: cats", and pumps his fist out the window of his sedan.

"i knew it!"

nb all doctors everywhere do "diagnostic interventions" a lot, it isn't limited to those two (nor are they Bad For Your Health). but for some reason i feel like "...holy shit it worked" is very slightly more endemic to surg and psych than other specialties. whereas in neurology they tell you EXACTLY and in great detail what is wrong with you and then shrug and go write a paper about it (BOOM!)

nb nb i'm not really this flip about people's health, btw, but this thread and a handful of friends are where i feel comfortable with some levity

Your search - "evinces zero abdominal symptoms" - did not match any documents.

Everyone has symptoms, there's always going to be symptoms in cats syndrome, that's the diagnostic hallmark. Wouldn't be much of a syndrome if there were no symptoms or signs.

In neuro we can sometimes say exactly what's wrong, but a lot of the time I'm more like, "yep, that kind of thing can happen in a normal brain, it's just changing up tricks on you, nbd, hang in there champ".

I like the idea of cats syndrome

Patients suffer terrible disfigurement, sometimes permanent.

http://the-void.co.uk/wp-content/uploads/2008/06/CatsTOP.jpg

hey geebs and others: can i ask a semi obscure health/surgical question here and get directed toward answers? i've tried the vast array of med website symptom porn out there, trust.

I figure it is reasonable to provide a forum for that and for me to be all bitchy about residency (I had to do a random night float yesterday u guyz, I was very sleepy and had to do a wad of admissions): The thread where we are physicians (and/or surgeons)

Also really maybe I just want to have this thread to hear stories of ERASing and interviews and such

haven't posted itt in a while

month 3/9 of 4th year pharmacy rotations now over. i've been at this particular site for a couple months now (my university's namesake health center) and am really bummed that i have to change sites next week. the medical team i worked with was so, so great - i put in so many hours of extra work researching things for them, reading on my own so i could hold my own in rounds the next day, just generally trying to impress them. i admired my attending so damn much - not only her ridiculous knowledge base and confidence, but the way she talked to patients; the way she talked about caring for patients; how she was given to editorializing in the middle of rounds about the way we (big we) cared for patients, how we fail patients, who gets left behind. i worked exhaustively on a clinical research project that resulted in some major shit-stirring (in a good way!) in the hospital and some small but positive policy changes, which I was pretty proud of. the project also involved lots of just talking to patients every day by myself; all the health care peeps itt know what it's like to talk to a patient and feel like they trust you completely, that you're really reaching them. it doesn't happen with every patient but it's what makes working in health care worthwhile. overall the months went well & i secured a couple of what i think are strong recommendations for pharmacy residency...

and yet, i realized for sure over the last couple of months, after a year or two of wavering, and after having long talks with a lot of people, that i actually want to be a physician. lol. i met with one of the deans of admissions to the med school yesterday to chat about my path and things i'd have to do to strengthen my candidacy. i talked today with a couple of the attendings i'd worked with here to ask them to stay in touch w/r/t recommendations and shadowing (which i think seems kind of silly given that i'll have had 2-3 years experience of direct patient care and working directly with physicians by the time i apply, but the admissions dude made it pretty clear formal shadowing is a must). i'm pretty much knee deep in the pharmacy game at this point, so my 'plan' is to finish a residency and work part-time following that, taking the classes i need to take and studying for the MCAT, and applying for 2015. i'm kind of scaring myself because i am getting more and more serious about this, and no one in my life will tell me STOP THIS IS A TERRIBLE IDEA, which i had sort of been counting on, but there you go

ONE OF US! ONE OF US! ONE OF US!

Seriously that is a rad and gigantic decision and worth doing (at least in my experience as a guy who worked 13 hrs overnight yesterday and was mopey the whole time). The shadowing and various other hoops of fire are not like NECESSARY or else you will die, but I can say as a dude who interviewed a handful of prospective students last year, there are almost definitely more applicants who are basically fine candidates on paper than there are spots, so some of the silly nonsense is there to make sure you check off all the right boxes to let you proceed to the interview stage. And there basically is where being a guy who figured out he wanted to do medicine midway through doing something else is most beneficial, because you will know 100% why you want to put yourself through this, and the unyielding horde of dark-suited 21 year olds with 3.8 GPAs and 34 MCATs do not always totally have that down yet.

whoa kev

right?

as i said it's something i've been moving toward for a couple years now - 'wavering' was a poor choice of words (especially so i would think when it comes to drafting a personal statement*). i've been thinking about this for a while but now i could not be more sure that this is what i want. my pharmacy education has been very good to me; i've made a lot of great friends and made some good connections in the field; i've thought for the last couple of years though that i really was interested in something different, something not really offered** by the current pharmacy curriculum. i've got some friends in medical school, plus my stepfather is a surgeon - i've toyed with the idea of medical school for a while now.

my suspicions/ideas were validated during my experiences over my first few months on rotations. i've come to experience the difference between pharmacy and medical educations firsthand by working with these medical teams ove the last few months - in pharmacy school we tend to focus more on what the recommendations are rather than what the actual physiology or evidence behind those recommendations are - i found this out a couple months ago when i began my gen med rotation at the health center - i remember an instance, forget what specifically, but i remarked that the recommendations for a particular patient was [x]...the attending i mentioned earlier replied with "ok, what's the evidence for that?"....this was new to me...in pharmacy school we were taught more to memorize the guidelines rather than to really probe the primary literature - you'd really be surprised by how few primary lit articles we were required to read! anyway the whole culture of pharmacy vs medicine was different like that...so i spent most of that month somewhat neglecting my pharmacy responsibilities (though i still got an A) and instead did a lot of
independent reading for my medical team to try to keep the pace with them...that is what interested me more

anyway my very pretentious observation, which i've noticed all throughout pharmacy school, is that pharmacy students tend to be sort of incurious in this regard; i guess very few of my peers were interested in the same things i was, whether it was literature or ways of studying for things; as i mentioned before, in pharmacy school tests were very much geared toward the slides delivered for a particular lecture or etc rather than really evaluating primary medical literature. we're taught to know 'facts' rather than to think through a particular case. i grew bored of this kind of studying i guess

working with medical students, medical interns, and residents over the past few months, i've gotten to appreciate exactly the kind of work a rising physician has to put in to stay afloat in this world. when i was 18, this wasn't a life i'd have wanted for myself; even a few years ago when i entered pharmacy school, the rigors of medical school and keeping up with the literature is not something i'd have thought myself ready for or willing to take on. over the last few years, tho, my values regarding methods of education have changed; i've found myself more interested in the MD world of education, the constant reading that entails, etc. maybe most importantly, clinically, i've worked with physicians and pharmacists and envy the relationship physicians can have with patients; in pharm school we're 'taught' that pharmacists are the most accessible HCPs, which i suppose is true enough; yet i'm convinced esp recently that physicians have the most meaningful relationships with patients - they trust yall the most - plus it is physicians who have the final say anyway.

i've been drinkin a little so i'll fix any problems tomorrow...but yeah, med school, i likes it

i'm hella rambing i think, sorry

you've got some asterisks to follow up on too ;)

FOUR MORE YEARS, FOUR MORE YEARS

you could polish that up into an application personal statement!

congrats k3v!

ha, i didn't really explain the pharmacy vs medicine thing very well. i'll have to be a little less *makes drinky-drinky motion* when it comes time to actually compose a personal statement. most of that was written on my phone on a car ride home from a bar, so excuse the typos and general drunkenness ;)

i think what c-l mentioned earlier is important. i think it's beneficial for me, not just as an applicant but for my general health, that i came to this decision somewhat organically. as i mentioned i'd been thinking about it for a couple years and more recently doing a little research into it, but actually working with physicians, resident physicians, medical students, etc (as well as nurses, patient care assistants, dietitians, physical therapists! all of whom do amazing work!) and getting to know the way they think, the way they approach patient care, the way they learn, has made me sure that medicine is what i want to do. to reiterate - and this is important for me i think in terms of a personal statement, interviews, etc - it's not just that i've decided that i don't want to do pharmacy (because my pharmacy education has been and continues to be very good to me), but specifically that i've gotten an extended taste of this doctor stuff and have decided that *this* is what i want to be doing. put another way, my change of career trajectory isn't motivated so much by a negative thought ("i don't want to do this") but by a postive thought ("i want to do *this*"). so *being a physician* is what i want to do; i'm sure of it; this is something the admissions guy i met with impressed upon me too - playing devil's advocate, he was saying "ok, so you've had this change in career trajectory. what makes you sure, or makes us at the school sure, that you won't want to be a dentist in a few years?". so that's something i'll have to figure out how to articulate when the time comes - which is still a ways away, haha. if i were running a campaign for presidency i've just formed an exploratory committee - talking to people in the know (what exactly do i have to do to do this?) and networking (with my physician acquaintances i've made, people i've impressed: "look, if i do do this, you have my back, right?") - and haven't announced my candidacy just yet. lots of work to be done. and again, it'll be a couple years before i actually begin applying. i'll be an old man at that point

xp haha!

Yeah I came to this from an entirely other kind of graduate study and I remember my first interview was with a guy who was CONVINCED I was going to somehow abandon medical school and go back to my graduate studies. I pretty much burned down my PhD bridges and turned down a not-small sum of money to stay in graduate school for the not-guaranteed chance to enter medicine. I think there are some people who will just assume that anyone who comes to this later in life than like, age 16 is not fully into it.

But then I interviewed with other places (specifically the place that let me in) where it couldn't have been more of an asset. Med school interviews are weird, that's why it helps to have a lot of them.

http://sphotos-b.xx.fbcdn.net/hphotos-snc7/581551_882263115486_1092645578_n.jpg

another exciting friday night

http://www.guardian.co.uk/society/2012/oct/28/lovesick-patients-stalk-doctors-online

gbx, C-L: you dudes were a little older when you entered medical school, right? did you have all of your prerequisite classes taken by the time you'd graduated or did you have to "go back" and take a few classes? i had a (terrible) meeting with my school's pre-med advisor i'd set up so i could ask him questions such as you know, where i should take these classes i need etc; when he wasn't depressing me with his indifference he did impress upon me the idea that it is definitely preferable to take these classes at the main campus as a full-time student rather than taking part-time or "night classes" or at the satellite campuses etc. which i mean, in a way, duh, but given my situation (i plan on working part-time after i graduate this spring) this may not be feasible or even possible. what were your experiences, if any, wrt this?

I was 26 when I started, yes. I had been a pre-med as an undergrad, but a pretty indifferent one with a couple soft spots (enough to apply to all the schools who were literally just "1 year orgo, 1 year G chem, 1 year physics, 1 year bio", not enough for "it'd be super if there was some statistics, and maybe some biochem"), so I ended up taking a few classes elsewhere (a summer school Statistics course at UC Davis when I was in San Francisco, a set of biochemistry courses through UCLA Extension at night, and a bio course at UC Irvine during Summer school as well) while finishing grad school/working. I do remember being told specifically NOT to pursue things like community college-level coursework, even for the basic prerequisite-level Bio/Chem/Physics courses, because it is regarded unfavorably compared to taking the same courses at a 4-year school level. I assume the same would apply to online coursework. I GUESS it is preferable to do full time study (that way you are properly taking your courses against the unyielding herd of premed robots) but if you are taking university-level coursework (which includes stuff like University Extension courses as far as I know) then you're demonstrating you are capable of handling the material. The location matters, since an A at a place where an A is understood to be an achievement is better than a place where everybody gets an A, and both are preferable to a place nobody has ever heard of where an A possibly means nothing.

The problem with being a non-traditional applicant, really, is that many of us have really unique situations that do not project out as well. I am pretty sure if I existed solely as undergrad me, coming out of my large well-known undergrad school with my GPA and my MCAT score, I could have determined a rough probability of my acceptance. Instead, I had my undergrad GPA and my MCAT plus also I was going to be a historian of medicine for a minute, and then I wasn't because I wanted to be a doctor, and I was pretty sure that I was one of no more than a handful of applicants (and possibly the only applicant) ever who presented a similar story. I felt I was qualified enough for acceptance, but I had zero idea whether that was actually going to happen until interviews started coming in, and I could peg myself to the probability of x interviews = y chance of acceptance to one of them.

I feel like this is possibly where your pre-med advisor is coming from; they definitely know what it takes to come from your school and get into med school because that's what they've experienced. Like, I dunno, let's say 4% of undergrads there with a 3.3 GPA and a 28 MCAT get in somewhere, and 50% of kids with a 3.5 and a 30, and 99% of kids with a 3.9 and a 40 (it's never 100%; I like to think this is because a small percentage of super-over-achievers are either terrible sociopaths incapable of human interaction, or just spazzy Asperger types). Those aren't the exact numbers, but the exact numbers exist somewhere, and you could be easily matched to them if you didn't have this weird "Pharmacy school" data point in the way.

yeah that's the thing, i really have no idea whether that's a positive or a negative thing. i think it's a positive, and i'm certainly going to use it as a positive when it comes personal statement time and (hopefully) interview time. my main issue right now, other than finding a job for the time being, is figuring out where and when i am going to take these classes (and there are quite a few i need to take). i just sent a long email to one of the deans of admissions at uconn, whom i met with a few months ago (via a mutual friend) and was really kind and helpful. gah

i was in a similar situation when i was applying - i hadn't really considered med school until my undergrad was mostly over and so i had to take three courses post-graduation to meet the prerequisites to apply. i just took them at my undergrad alma mater - the admissions office was p understanding and i didn't really have to do to much other than book an appointment and pay for the classes. i never had the impression that it made much of a difference in my interviews although i think it did make a difference in how well i actually did in the courses themselves, since i was working a reasonably demanding f/t job while taking them. and ime my interviewers seemed more interested in the work that i was doing btw graduating and applying than my marks in the courses i had taken, which i feel just kinda got rolled together the rest of my undergraduate performance. so i guess my advice would be to put some serious thought into what sort of work you'll be doing outside of your coursework as that 's probably what's going to set you apart in the application process

i had basically zero pre-med courses under my belt at graduation: upper-level math, english, and i'm not even sure those are required anymore.

i didn't want to take two years for a post-bacc, so i applied to a "dedicated" program at montana state for no reason other than it was in montana. i was actually their first-ever applicant (the website went live before the program had been approved by the board of regents), and i was basically accepted over the phone.

it was the first year of the program AND the person running it was transitioning to a new job out east, so it definitely wasn't as smoothly run as some of your fancier post-bacc programs. and really, it ended up being almost equivalent to enrolling in undergrad courses and going part-time: all our classes were with the undergrads, and according to their scheduling needs. this meant only 2-3 courses at a time (max), and spread out over 15 months. i actually had to take a few more classes than others, because my current med school (and where i had expected to have the best chance of matriculating, being my home state) was one of the last remaining to require stuff like biochem and english and stats and psych and so on. i think a lot more schools have pared it down to phys/chem/orgo and basically nothing else?

if it had been possible to even ~get~ a job, i probably could've managed it, but work is hard to come by out there. only one of my cohort was working, but she had already lived in town for a few years, and was and is a superhuman (40+hr/wk as an EMT, pulled a 4.0 and a 39 on the MCAT...went on to attend my alma mater's med school and is now a gen surg resident. this woman was a DRAMA major, ppl)

that said, i think C-L/Lamp are right about the focus largely being on what you're doing with your time that ISN'T post-bacc classes. post-bacc students, even at the boot-campier programs, have the luxury of being pre-meds w/o the distractions of humanities requirements and being idiot 20 year olds. i think schools likely hold their performance to a slightly higher standard if they're going full-time and not working. otoh, if you're actually doing shit while ALSO taking classes, that demonstrates ~gumption~ and the ability to manage yr time and so on, so maybe they'll give you a break.

i'm not really the best person to ask, in a way---i only landed two med school interviews! otoh my "missing years" were a lot weirder and tougher to explain coherently than yours, k3v, pharm school ought to be a feather in yr cap. i was applying as an english major (and one with a marginally above average undergrad GPA from a fancy school), who had made a documentary (never picked up) on and off for a couple years while working shit jobs (blatantly ski bumming), then worked as an ad writer, then did a post-bacc, then worked shit jobs again and "played in a rock band" while submitting applications in my "gap year." i had very solid post-bacc grades from a western land-grant university that i clearly went to in order to be near the mountains, an above average MCAT (hoisted to the right of the curve almost entirely due to the reading/language section), a string of volunteer experiences that weren't long-term since i moved so much, and lots and lots of good stories that no one would ask me or care about.

one attending who had worked on an admissions board told me that i must've been "catnip" to med schools (i wasn't), while others have looked at me with varying degrees of confusion and/or suspicion when they hear about my pre-medicine life (lives), like "who let you in?"

tl;dr i'm sure you'll be fine.