To “Gap Year” or not to “Gap Year” Before Medical School? A Shakespearean Question of Benefits, Challenges, and Opportunities.

INTRODUCTION

Historically the “traditional” path to medical school was a direct one. It often involved matriculating into medical school immediately after completion of their bachelor’s degree. However, with the modern day written and unwritten requirements, many students decide to forgo application and take one or more gap years. According to the 2024 Matriculating Student Questionnaire (MSQ) given by the American Association of Medical Colleges,¹ 74.3% of new incoming matriculants take at least one gap year before starting medical school. Most of them worked at another career (50.2%), worked/volunteered in research (50.0%), or worked to improve their finances (41.3%).¹ Others helped fulfill family obligations (24.4%), pursued graduate studies (19.2%), continued coursework to fulfill premedical requirements (10.7%), worked/volunteered internationally (8.6%), or took premedical courses for the first time (4.2%).¹ Despite the broad descriptions, these answers provide direction to what medical school admission committees could be looking for. These answers also help outline how prospective medical students can effectively fully utilize their gap year.

In this review, we aim to explore the benefits and challenges of a gap year between college and medical school, as well as identify options for what students may do during their gap years.

METHODS

We conducted a comprehensive review of peer and non-peer reviewed literature published between 2008 and 2024, online media articles, online content published by medical school consulting companies, official college websites, online discussion forums (Reddit, Quora, Student Doctor Network), online blogs, and YouTube videos.

The entire team of authors identified the key literature findings that are summarized in this article. According to VA Boston Healthcare System policy, our literature review study does not require an Institutional Board Review.

RESULTS

Some of the benefits and challenges of taking gap years before medical school are summarized in Table 1.

Benefits of Pre-Medical Gap Years

1. Time to fulfill course requirements for medical school application

In 2024, about 18.5% of matriculating medical students that responded to the MSQ decided to pursue medicine during or after junior year of college.¹ These pre-medical students that may not have had enough time to meet all the pre-requisites for medical school have the option to do a post-baccalaureate program that will allow them to complete the required courses. Students that may have decided to pursue medicine later than most still need to complete biology, physics, and organic chemistry courses to apply to most medical schools.² These post-baccalaureate programs are known as career-changer programs, which fulfill med-school requirements while also providing exposure to high level science courses.³

2. Improving medical school application

Students that may have struggled in their undergraduate studies have opportunities to boost their GPA. They may decide to enroll in a master’s program, such as a master’s program in public health or medical science. Another option that students may pursue is an “academic enhancer” post-baccalaureate program.^3,4 These programs are designed for medical school applicants, so there are often opportunities for shadowing, volunteer work, and Medical College Admission Test (MCAT) review.⁵ In practice, these programs are for students who need to bolster their GPA, because these programs can be quite costly. In the 2024-2025 matriculating year, the average GPA of all medical school applicants was 3.66 with the average of all matriculants being 3.79.⁶ Gap years can also give students more time to adequately prepare for the MCAT exams as well as more opportunities and time to network and build relationships that could help them secure stronger letters of recommendation.

Certain post-baccalaureate programs are “linkage programs,” which are affiliated with one or more medical schools. Table 2 displays the post-baccalaureate programs with the highest number of linkages and their respective medical school linkages, which were compiled from the AAMC post-baccalaureate program database⁷ and the official websites of each program. Linkages are essentially admission agreements between medical schools and post-baccalaureate programs. However, it does not guarantee admission, but instead provides preferred consideration for admission. Students still need to meet the required MCAT score and GPA for these medical schools. Also, many linkage programs have binding agreements, which limits students to only applying to one linked medical school. Some schools like Washington University in St. Louis look at undergraduate GPA and graduate GPA separately, so academic-enhancer students may not benefit from certain linkage programs.⁸ However, these programs can be incredibly useful if the student has a specific school that they want to attend.

Students may also decide to utilize the gap year to improve on their amount of research or clinical experience. Some common jobs students work to gain clinical experience are as a phlebotomist, emergency medical technician (EMT), medical assistant, or medical scribe.⁹ These jobs all have certifications that can be obtained in less than a year and provide experience with direct patient care. Students that may need more research experience now have time to truly dive deep into a research project and potentially secure a publication.¹⁰ Obtaining a job as a research assistant is one path a pre-medical student may consider post-graduation. In 2021, there were 191,965 research assistant positions in the US.¹¹ Taking a position as a clinical research assistant may also provide clinical experience alongside opportunities to publish. Overall, all these positions provide meaningful experiences that can enhance a student’s medical school application.¹²

3. Saving money

Medical education is expensive, with about 85% of medical school graduates having education debt.¹³ In 2024, the average debt incurred by medical students from medical school and pre-med undergraduate education was $264,519.¹⁴ This figure also does not include any non-educational debt that students may have, including car loans or medical debt. During their gap years, students could save some money and possibly begin repayment of existing debt to cushion the debt load once medical school begins. Even if a student did not receive any undergraduate debt, it is still beneficial to set aside some money to help cushion the cost of medical school and to take out fewer loans.¹²

4. Reflecting and recharging

The pre-medical experience is stressful, and the application process adds another layer of pressure on top of that stress. Premedical students that experience burnout syndrome and depressive symptoms during their undergraduate studies are significantly more likely to depart from the medical career path.¹⁵ Both the competitiveness of a pre-med student’s undergraduate studies and the constant judgement of the student during the application process can have a significant negative impact on a student’s self-image.^16,17 Taking a gap year provides time for students to mentally reset and rebuild their self-confidence. They may take this time to reconnect with a passion that they may have had to sacrifice while completing their undergraduate degree.¹² Gap years can also provide time to refocus the student’s goal of becoming a doctor. In the process of applying to medical school and being caught up in studying, the endpoint could get lost. The experiences that a student can gain in their gap year can also help reinforce their motivation to become a physician.¹⁸

5. Improving emotional intelligence and maturity

Gap years provide time for students to experience adult life outside of school. This time allows for students to mature and develop their emotional intelligence (EI), defined as the ability for an individual to recognize, understand, and express emotion. EI is a trait that is important not only for patient interaction, but also for working in a team environment. A study done at the University of Manchester¹⁹ compared the ease of transition from classroom learning to clinical rotations between mature and non-mature students. Anyone over the age of 21 at entry to medical school was considered a mature student. The study showed that mature students expressed an easier transition to the clinical environment than non-mature students. In a similar study, the EI of resident physicians that took a gap year before medical school was compared to the EI of those who went straight to medical school from college. This study found that residents that took a gap year before medical school scored higher in interpersonal skills, empathy, decision-making, and impulse control.²⁰

Furthermore, students that work during the gap year may feel more natural in the fast-paced workplace that is a hospital. Even volunteering during a gap year can aid in developing a student’s empathy and professional skills.²¹ EI and maturity form the building blocks of patient-centered care and are integral in forming patient-physician trust.²² Therefore, experiences that aid the development of EI and maturity may improve a student’s chances at getting into medical school, as well as improving their future quality of care.

6. Reducing future burnout

Burnout is a common trait shared among up to 56% of medical students and can potentially lead to future dissatisfaction in medicine.²³ Pre-medical students that experience burnout in their undergraduate studies also show a significant reduction in medical career interest.¹⁵ In the cross-sectional study of burnout performed by Guang et al. medical students that took at least one gap year displayed significantly less symptoms of burnout compared to students that did not.²³

Challenges of Pre-Medical Gap Years

1. Potential negative impact on the medical school application

Gap years should be utilized correctly for them to be beneficial to an applicant. As stated in the AAMC’s guide to gap years, these years are not “time off”.¹² Gap years without an attempt to gain meaningful experience could reflect poorly on a student’s application. Admissions committees may view an unproductive year as a lack of focus and could question an applicant’s commitment to medicine.²⁴ Gap years are not mere vacations, and if the admissions committees cannot identify meaningful experience, then they could assume that there is a lack of commitment.

2. Delayed start to medical school

The path to becoming a doctor is a long and arduous road. After graduating high school, it can take between 11-18 years, depending on one’s desired specialty, before practicing as an attending physician.²⁵ This delayed start also means starting residency later, and eventually a later start as an attending physician. Also, there is currently a projected shortage of between 13,500 and 86,000 physicians by 2036.²⁶ Without a gap year, physicians with a 3-year residency will work 36 years on average and physicians with a 7-year residency will work an average of 32 years before retiring.²⁷ Theoretically, each gap year taken reduces the years eventually spent practicing as an attending physician. With the AAMC’s projected shortage of physicians, gap years potentially could have a societal cost. Overall, the length of a medical education and the length of a medical career need to be taken into consideration when deciding whether to take a gap year or not.

3. Readjusting to student life

Some students may see themselves separating from academia during their gap year. The study habits that they have refined and developed during their undergraduate years may not be used during this gap year. For some, they may be able to dive right back into intense studying, but for others it may be a rough transition back into the student life.²⁸ The amount of information that is studied during the first year of medical school is often equated to drinking from a fire hydrant. Prolonged breaks from studying can make it difficult to adjust to the intense study schedule that is required to succeed in medical school.

4. Potential loss of focus

Being separated from medicine for an extended period can cause the student to lose sight of the overall goal.²⁸ During this time, students may begin to have doubts about a future in medicine. With the nature of medical school applications, self-doubt can become an obstacle on the path to medicine.¹⁷ In some cases students may find opportunities outside of healthcare that could provide them a stable career. Overall, gap years provide more opportunities for pre-medical students to get distracted from the goal of becoming a physician.

5. Potential to affect equity in medical school admissions

The prevalence of gap years before medical school may be contributing to inequity in medical education. Applying to medical school is already a large expense, with the first school fee being $145 and each subsequent school costing $46.²⁹ The costs of attaining a medical education already poses a substantial obstacle for low-income applicants. Medical education has historically had an element of elitism that made it difficult for underrepresented minorities to get admitted to medical school. After the Flexner Report was published in 1910, many medical schools that focused on serving impoverished an underserved communities were closed. The shift in priority of medical education transferred to a shift in admission requirements, which put underrepresented students at a disadvantage.³⁰

Financially disadvantaged students may not have the ability to take unpaid research positions or afford an expensive post-baccalaureate program. The opportunities that gap years provide are not necessarily accessible for all pre-medical students. With 74.3% of matriculating medical students in 2024 taking a gap year, the standards for admissions continue to rise.¹ An increased focus on extracurricular activities for admission puts first-generation pre-medical students at a disadvantage because they might have less connections to healthcare.³¹ This could mean less opportunities to shadow, less clinical experience opportunities, and less opportunities for research. All of these are essentially required for admission to medical school, and students that take gap years have significantly more time to pursue these activities. In the 2024 matriculating student questionnaire, 50% of matriculating students that took a gap year used that time to work or volunteer in research.¹ The average salary of a research assistant in 2024 was $41,414, which is not enough to live comfortably in any major US city, especially if the student needs to support their family financially.^11,32

Overall, gap years have become a tool that students use to strengthen their medical school application. However, the growing trend of taking gap years has potentially exacerbated the admission inequity that underrepresented, and financially disadvantaged students faced in the past.

6. Financial considerations

Taking gap years before medical school could have both immediate and long-term financial implications that should be considered carefully. Post-baccalaureate or master’s programs during gap years are expensive and can add to the overall educational costs. Furthermore, living expenses and potential travel during gap years can be costly.

In the long term, every year postponed is a year of loss of potential earnings, lost retirement savings, and lost career growth. Delaying medical school admission for one of more years could also mean that medical school tuition will likely be more expensive when the student finally matriculates because tuition rates in US universities and colleges usually increase each year at about twice the general inflation rate.³³

Gap Year Options for Pre-Medical Students

Gap years can be incredibly beneficial to a student’s medical school application if they decide to use their time strategically. There is a plethora of options for non-traditional students to fulfill course requirements. There are just as many programs designed for students needing to bolster their GPA.

Some students may opt to find a job during their gap year. There are a variety of jobs that pre-medical students can work that will both make them money and help strengthen their medical school application. Increasing clinical hours through either direct patient care or clinical research can help strengthen a pre-medical student’s medical school application. For example, becoming an EMT, clinical research assistant, medical scribe, certified nurse assistant, or certified medical assistant can help strengthen an application by exposing the applicant to patient care.³⁴

Students may also want to take time during their gap year to volunteer for a cause they care about. For example, volunteering as a patient ambassador at a Veterans Affairs hospital or helping with public health initiatives at a homeless shelter both do well to strengthen a pre-medical student’s application by keeping them connected to healthcare.³⁵ Students may also opt to do longer term volunteering such as the Peace Corps or AmeriCorps. The Peace Corps may be an option for students who wish to travel internationally while also creating a positive impact on the community they serve in. Peace Corps assignments are 2 years of service with 3 months of training. Peace Corps assignments cover a wide variety of subjects including health, education, economic development, youth development, agriculture, and environment.³⁶ Similarly, the AmeriCorps provides service assignments that support the environment, build affordable housing, provide disaster relief, and work alongside various nonprofits to enrich the community. Unlike the Peace Corps, the AmeriCorps service assignments are all based in the US. Each assignment is 10 to 11 months long and consists of various service projects around the country.³⁷ Both the Peace Corps and AmeriCorps provide incredible opportunities for students to do good for humanity while also strengthening their medical school application. Importantly, time spent serving as a full-time AmeriCorps or Peace Corps volunteer during gap years counts towards the Public Service Loan Forgiveness requirements.³⁸

A list of selected common gap-year opportunities for pre-medical students is presented in Table 3. Importantly, students can learn about many other available opportunities by connecting with their college’s pre-medical advisors and/or alumni.

Regardless of whether the student decides to attend a post-baccalaureate program, get a job, or volunteer, all these options provide meaningful experiences that can strengthen a medical school application. These all have a connection to medicine, whether it be through healthcare-oriented research, direct patient care, or service to others. What is most important is that the student gains meaningful experiences from their gap year that will guide them on their path to becoming physicians.

CONCLUSIONS

Not every pre-medical student will want or need to take a gap year before medical school, and not all gap years are created equal. Pre-medical students need to spend their gap year strategically by participating in activities that specifically strengthen weak points in their application. While improving their application, it is important for students to also take some time for themselves to find an activity that they enjoy doing, pursue a passion, or just unwind and recharge. While taking a gap year before medical school can be valuable, it is crucial to approach this decision with a clear understanding of the potential benefits and challenges.