When COVID-19 restrictions reduced his work schedule, Sam Smith turned to another time-consuming task: applying to medical school.

He’d always wanted to go into medicine, Smith said. But what was happening in the world had a big impact on the kind of medicine he hopes to practice. Now, Smith said, he wants to specialize in infectious diseases.

The experience of the last year “makes me think, there’s probably going to be another pandemic” in the future, said Smith, 25, who has an undergraduate degree in chemical engineering from the University of Colorado Boulder and moved to Somerville, Massachusetts when his girlfriend started Harvard Law School. “So I want to be on the front lines of the next one.”

Even as college and university enrollment overall has dropped this fall, Smith is part of a wave of what officials say is an all-time record number of applicants to medical school.

The number of medical school applicants is up 18 percent this year over last year, according to the Association of American Medical Colleges, or AAMC, driven by the example of front-line medical workers and high-profile public health figures such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Renewed attention to inequities in the delivery of health care has also played a role.

“It’s unprecedented,” said Geoffrey Young, the AAMC’s senior director for student affairs and programs, who compares it to the response to another traumatic moment in American history: the terrorist attacks of September 11, 2001.

“After 9/11, there was a huge increase in the number of men and women that were entering into the military,” Young said. “So far in my lifetime, at least, and for as long as I’ve been in medical education, that’s the only comparison that I could make.”

The Stanford University School of Medicine reports a 50 percent jump in the number of applications it received this year over last year, or 11,000 applications for 90 seats. New York University’s Grossman School of Medicine says it’s seen a 4 percent increase, but that comes on top of a 47 percent rise last year after the medical school made tuition free; this year, it has more than 9,600 applications for 102 spots. The Boston University School of Medicine says applications are up 27 percent, to 12,024 for about 110 seats.

“What’s been happening this year is that more of the people who had at some point thought about medical school decided to stick with it,” said Dr. Kristen Goodell, associate dean of admissions at the BU School of Medicine. “And that, I think, may have a lot to do with the fact that people look at Anthony Fauci, look at the doctors in their community and say, ‘You know, that is amazing. This is a way for me to make a difference.’”

Medical school admissions officers have come up with a name for this. They call it the "Fauci Effect."

Ryan Chahal, who is also applying to medical school, is among those inspired by Fauci, he said.

"There definitely was a Fauci Effect for me,” said Chahal, 25, who lives in Tampa, Florida. “People who are interested in medicine are interested in evidence and evidence-based approaches to things, and he has been very evidence-based.”

Fauci said he’s gotten hundreds of letters from people telling him they want to practice medicine.

It’s “very flattering,” he said in an interview via Zoom with GBH News. “I think probably a more realistic assessment is that, rather than the Fauci Effect, it’s the effect of a physician who is trying to and hopefully succeeding in having an important impact on an individual’s health, as well as on global health. So if it works to get more young individuals into medical school, go ahead and use my name. Be my guest.”

Among other reasons admissions officials cite for the increase in prospective medical school students is that the pandemic has given many people more free time to complete the arduous application process.

Normally, before applying to medical school, nearly half of all applicants first spend a year or two after college working, traveling, doing research, pursuing master’s degrees or volunteering, Young said.

But this year, “a lot of the plans they made post-grad honestly fell through,” said Dr. Sahil Mehta, founder of MedSchoolCoach, which prepares students for the Medical College Admission Test (MCAT).

“We saw a lot of students who said, ‘You know what? I’m going to apply this year,’” Mehta said. “Maybe they were on the fence and they saw what was happening. They saw that health care workers were really at the forefront of trying to solve this. It really lit a fire under people.”

When the dermatology practice where she was working as a medical assistant shut down temporarily because of COVID-19, Mary Grace Kelley had the chance to retake the MCAT, and she significantly improved her score.

“This is a perfect time of no distractions,” said Kelley, 23, who lives in the Boston suburb of Natick and is applying to medical schools this year from her childhood bedroom in her parents’ house, which is decorated with team photos and varsity letters from her time as an undergraduate Division I hockey forward. “I’m not very good at sitting still.”

Mary Grace Kelley, a medical school applicant, sits outside of her Natick, Mass. home on November 25, 2020.
Meredith Nierman The Hechinger Report

Some institutions also waived the requirement that applicants submit results from the MCAT, which canceled several test dates in the spring. Stanford, which is among the schools that made the MCAT optional, reports that 5 percent of applicants did not submit a score.

Medical schools have received so many applications that admissions officers — many of them working remotely — are struggling to keep up with the volume. “My mailbox is almost full with emails apologizing for the delays,” Chahal said. “They’ve just had a huge number of applications.”

This deluge comes as the nation faces a projected shortage of physicians, and its aging population is requiring more specialty care.

The United States will be short 54,100 to 139,000 physicians by 2033, the AAMC estimates, while the proportion of people who are over 65 is expected to grow by 45 percent. More than two out of every five doctors now practicing will reach retirement age in the next 10 years.

Already, there are fewer primary care providers than is needed — internal medicine doctors, family physicians and pediatricians — in nearly 7,200 areas of the United States with a combined population of roughly 82 million people, according to the Kaiser Family Foundation. Thirty-five percent of registered voters in a survey last year said they’d had trouble finding a doctor, up from 25 percent in 2015.

The bad news for the surge of applicants is that medical schools aren’t likely to expand to accommodate them next fall, meaning that the odds of getting in this year will be much lower than usual.

“It’s discouraging a little bit, to be honest,” Smith said.

And while 30 new medical schools have been accredited since 2002 — bringing the total to 155 andincreasing enrollment by 33 percent — there has been almost no increase since 1997 in Medicare payments for residency training, which costs an average of $171,855 per year, leaving hospitals to either limit the number of residents or cover the cost themselves.

Medical school graduates finish with a staggering $241,560 of student loan debt, on average, according to the latest available data from the National Center for Education Statistics, discouraging many would-be doctors, including those from low-income and ethnic and racial minority groups.

Eight percent of medical students are Black and 7 percent are Hispanic, both proportions smaller than their share of the population. (Ten percent of medical students identify themselves as multiracial.)

“I do think that the debt probably scares off some people,” said Goodell, who is also a former chair of the Council on Graduate Medical Education.

Managed health care and more red tape and bureaucracy have also soured some people on careers in medicine, said Mehta, a practicing radiologist.

“That really started to disenfranchise the ways physicians practiced medicine. They were getting burned out,” he said.

This year’s many medical school applicants appear undeterred, however.

“Everyone feels some sort of responsibility,” Kelley said. “We are basically the next generation. We’re going to be taking care of our parents, grandparents. So there’s definitely a call to arms thinking that, if there’s another pandemic, it’ll be up to us.”

Mehta expects the trend to continue.

“Given that about 60 percent of people [applying this year] won’t get in, you’re probably only going to see an increase in competitiveness next year,” he said. “The bigger thing is you now have people who are freshmen in college, sophomores in college, juniors in college, or even in high school, who for the last few months have been watching Dr. Fauci on TV and thinking, ‘Maybe this is for me.’ ”

Fauci said he sees the flood of medical school applicants as a sign that people are thinking about social justice — “that you have responsibility not only to yourself, but as an integral part of society,” he said.

He added that he hopes the trend will counterbalance and “maybe would even overcome the other side of the coin, which is the really somewhat stunning and disturbing fact that people have no regard at all for society, only just focusing very selfishly on themselves.”

This story about medical school applications was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education, in collaboration with GBH News.