The Ultimate Guide to BS/MD Programs

What Is a BS/MD Program? Pros, Cons and Considerations

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Posted in: High School Students & BS/MD Programs

A BS/MD is a dual-degree program designed by an undergraduate university in partnership with an affiliated med school to provide high school seniors with conditional acceptance into medical school. Students receive a Bachelor’s degree and immediately enroll in the linked program to pursue their medical degree, assuming they maintain the program requirements.

Typically, these are 6-8 year programs (in contrast to the traditional 4 years of undergraduate + 4 years of medical school when going the traditional route). BS/MD programs are designed for students who’ve shown a high interest in medicine throughout their entire high school career. 

Only 3-5% of applicants successfully get into BS/MD programs. But 70% of our clients have received an acceptance — find out how you can, too!

BS/MD Programs: An Overview

A BS/MD program provides a streamlined path for students to earn both their undergraduate degree (a Bachelor of Science) and their Doctor of Medicine (MD) degree.

Note: BS/MD programs are one type of direct medical program (sometimes called baccalaureate-MD programs). Many institutions also offer BA/MD (a Bachelor of Arts) or BFA/MD (a Bachelor of Fine Arts), which are essentially the same except that the undergraduate degree is more in line with a liberal arts education.

The structure of these programs typically goes as follows:

Conditional Acceptance

High school students apply to BSMD programs and if they are accepted, immediately gain a conditional acceptance to medical school.

Undergraduate Studies (Years 1-3)

Students complete undergrad coursework, often in the sciences. These years should provide a strong foundation in sciences and include prerequisites for a college of medicine. Extracurricular activities, volunteer work, and internships should reflect a commitment to healthcare.

Their conditional acceptance is contingent on maintaining specified academic standards during the remainder of their studies.

Depending on the program, some BS/MD students will be required to take the MCAT at some point during their undergraduate career.

Medical School (Years 3-6, 4-7, or 5-8, Depending on the Program)

Students will transition into the medical school curriculum. Clinical experience becomes a focal point, allowing students to apply theoretical knowledge in real-world medical settings. Students take USMLE Step 1 and 2 and also begin to prepare for the residency application process, honing in on their chosen specialty.

How Are BS/MD Programs Different From Traditional Med School?

BS/MD programs differ from the traditional medical school route in several ways:

 Traditional Med SchoolBS/MD Program
When to applyDuring 3rd-4th year of undergrad or after undergrad if taking a gap yearDuring senior year of high school
Program length8 years or more (4 undergrad + 4 medical school + any gap years)6-8 years; accelerated programs may require summer classes
Medical school choicesUnlimited unless applying early assuranceMust attend the medical school associated with your undergraduate institution
Competitiveness41.3% of applicants are accepted to med schoolAcceptance rates at individual BS/MD programs are typically around 3% (other students may be deferred to standard application)
MCAT requirementsTest required to apply, score expectations vary by school, scores 511+ are typically considered competitiveMCAT is not required before applying to BS/MD; some programs require students to take the MCAT and meet a score requirement as part of their course of study
CostCost for full undergraduate degree plus medical schoolCost for full undergraduate degree plus medical school; less expensive for accelerated programs (6-7 years)

 

Students on a BS/MD or similar medical scholars program typically bypass the traditional medical school application process in their senior year of high school, committing to a single undergrad and med school.

Undergrad students typically apply to medical school the summer before senior year or after, depending on whether they take gap years. BS/MD students apply as high school students to both institutions.

BS/MD programs often have specific admission cycles, and the application process usually aligns with standard college application timelines.

The BS/MD workload can require students to attend classes over the summer, but in the end, it can reduce the overall stress and uncertainty of medical school admissions.

Students who are accepted into a baccalaureate-MD program will be automatically accepted to the linked medical program if they maintain the program’s requirements throughout their undergraduate education. 

Does a BS/MD Program Mean I Don’t Have to Take the MCAT?

Waived MCAT requirements were a previously common benefit of many BS/MD programs. But today, most BS/MD and similar programs do require students to take the MCAT before moving to their medical program.

In some cases, baccalaureate-MD programs require students to take the MCAT and achieve a minimum score or to take the MCAT but do not specify a score requirement.

Of the 55 dual-degree programs in the U.S., 16 totally waive the MCAT requirement for med school.

Here’s How Competitive BS/MD Programs Are

Many BS/MD programs take only 5-20 students per year. Applicants must have a high GPA, strong SAT or ACT scores, stellar extracurriculars, and solid letters of recommendation to matriculate. ​​Admissions want to see the applicant’s commitment to a career in medicine.

How hard is it to get into a BS/MD program? It is very difficult to get into a BS/MD program. Only 3.3% of med school graduates came from BS/MD programs in 2022, up from the 2.8% that matriculated in 2018. No organization compiles official acceptance data for these programs, so it’s impossible to know the exact acceptance rate across all institutions.

Enrollees are typically required to maintain a very high college GPA, especially in math and science coursework. The programs also look for a strong portfolio of extracurricular activities, volunteer work, or job experience related to healthcare.

These programs are so competitive because admissions committees are looking for the rare few students with enough maturity and focus to successfully tackle this compressed curriculum.

How to Know if BS/MD Is the Right Path for You

As a BS/MD medical student, you are essentially doing everything as you would if you were a traditional pre-med. The main difference is that you will do that work in a slightly condensed format, with the benefit of less pressure concerning whether or not you’ll get into medical school.

Is a BS/MD worth it? In theory, a BS/MD is very worth it, but only if you have the particular qualities required to excel in an accelerated program.

Read through our checklist and ask yourself honestly, “Does this sound like me?” If it does, a BS/MD program might be your perfect path:

  • I maintain good grades in school easily, especially in science classes.
  • I do well on tests like the SAT/ACT.
  • I have experience shadowing doctors, volunteer experience, and some clinical experience with direct patient interaction.
  • I know exactly why I want to be a doctor, and I’ve felt this way for a long time.
  • I’m confident that I want to attend one specific undergraduate school and medical program.
  • I feel comfortable working closely with the sick and injured.
  • I am a natural leader and can take charge as needed in school or community groups.
  • I can handle a busy school schedule while balancing other life factors like self-care and meaningful relationships.
  • I am ready to commit to being a doctor, and I understand how long and tough medical training can be.
  • I am interested in research, and I genuinely want to discover new things in medicine.
  • I could easily get strong letters of recommendation from teachers, especially in science.
  • I have excellent interview skills and feel very comfortable discussing why I love medicine.
  • I understand and am ready to fulfill the costs associated with a BS/MD program, including tuition and cost of living during school.
  • I have a back-up plan and I’m open to other ways to become a doctor, like traditional med school.

While BS/MD programs offer a unique path for students set on a future medical career, they come with their own set of advantages and drawbacks.

Pros

  • Early medical school admission: High school seniors who secure admission to these programs are ensured a place in medical school, provided they keep a specific GPA and meet minimum MCAT standards.
  • Lenient MCAT requirements: Certain BS/MD programs either exempt students from the MCAT or mandate the test without specifying a minimum score requirement. This approach aims to alleviate the stress related to MCAT preparation.
  • Time efficiency: Some programs integrate undergraduate and medical education within 6 or 7 years, as opposed to the conventional 8 or more. This expedited route not only conserves time and reduces tuition expenses but also enables students to begin earning money in their medical careers sooner.
  • Focused curriculum: With admission to medical school ensured, students in BS/MD programs usually dive straight into a curriculum centered on health sciences. This helps students establish a solid educational foundation from the start.

Cons

  • Highly competitive: Because of their distinctive advantages, BS/MD programs can be highly competitive. To distinguish themselves in the admissions process, applicants often require a strong GPA and high school extracurricular activities linked to healthcare. Acceptance rates at BS/MD programs are typically less than 5%.
  • Geographical limitations: The binding nature of these programs often requires students to commit to the same institution or a partner institution for both undergraduate and medical school. This might be okay for some students, but you might see it as a drawback if you want a diverse set of med school options or want to attend undergrad and medical school in two different places for more variety before deciding where you want to settle down.
  • In-state residency requirements: Some programs are only open to students who reside within that state.
  • Limited flexibility: These programs may not offer much room for exploration. This structure can be a disadvantage for students who later decide they want to pursue a different path or those who want a broader undergraduate experience.

Reality check: The concern about limited flexibility differs on a school-to-school basis. Some schools might reserve your spot in medical school while you take a few years off to pursue other graduate degrees, while others don’t allow you to do so.

This depends on the school’s philosophy. For example, REMS at the University of Rochester encourages students to take gap years to pursue fellowships or other graduate degrees because they believe this will eventually help them become better doctors.

The same mentality may not apply across other schools, though. Different schools will have different policies; the best way to find out is to ask such questions during your interview weekend.

4 Tips for Getting Accepted

BS/MD programs are known to be some of the most competitive programs in the country. (Some of their acceptance rates make Stanford and Harvard’s 4% acceptance rate sound like a cakewalk!)

While there’s no trick for guaranteed admission, there are 4 things you can do to make yourself a top-tier applicant:

1. Start Early!

Given that some of the most difficult BS/MD admission programs have an acceptance rate of nearly 2%, these universities are looking for students who have known for quite some time that they are interested in medicine and can show it.

Most students who are serious about getting into these programs don’t just wake up one morning of their senior year and make a spur-of-the-moment decision to apply. On the contrary, the top percentile of BS/MD matriculants know before they even step foot into high school.

It is important to stay involved with health-related activities during your high school years especially so that either: (1) You can decide this field isn’t for you after all, or (2) You realize that studying medicine is your path and you have the experience to back it up.

Whether it’s research, volunteering at a hospital or simply shadowing your family physician for clinical mentoring, it’s never too early to enter the field of medicine. Don’t wait until your senior year to go all in!

2. Get Those Grades

Secondly, keep your GPA high and study hard for your ACT/SAT tests. As previously mentioned, some of these programs have single-digit acceptance rates, which means having a strong GPA and a high ACT/SAT score is of utmost importance.

Some schools (such as Drexel University, Case Western, Penn State/Jefferson) require BS/MD applicants to be in the top 10% percent of their graduating class in terms of GPA and to have standardized test scores above a certain number.

Keep in mind, though, that even if a school doesn’t explicitly state a certain GPA or SAT/ACT score that they’re looking for, they still expect stellar statistics.

That being said, by no means will a 2400 SAT score and 4.0 GPA guarantee your acceptance into any BS/MD program. However, high academic statistics are an indication of academic maturity and will increase your chances of being considered.

3. Organize Yourself

My greatest piece of advice is to narrow down your list of colleges early (and by early, I mean by the end of the summer before senior year, at the latest).

Then, create an Excel sheet noting down all the important pieces of information in separate columns. It may be a pain to sit down one day and spend hours researching all the specific submission details for each university you are applying to, but it will largely pay off in the long run.

Some BS/MD programs require you to submit essays through email, while others have apps or website application portals.

Some have an earlier application date set for BS/MD applicants (sometimes as early as mid-November), while others ask you to submit at the same time as all other students in January.

Some may ask for 4 extra essays, while others simply ask you to check a box that indicates your interest in being considered for the program.

Each of these little details is unique to the program and can be easily missed. Rather than having to Google search every time you forget one tiny detail, having an easy-access document with all the necessary information is much simpler.

Take my word for it; this organizational document will quickly become your holy grail!

4. Be Resilient

Rejection is never easy. And though there is nothing you can do to change the outcome, you can remember to not take the results personally.

This statement holds for BS/MD programs even more so than it does with regular college applications. Most of these programs accept only a handful of students (10-15) out of the hundreds or thousands of applicants.

These programs are looking to maximize their diversity, and as you can imagine, that is quite difficult to do with such a small group of people.

Getting through the entire BS/MD process is an accomplishment in itself; it’s something not any and every student can do. It takes a great deal of commitment, maturity, and work ethic to get through this process successfully.

Those are the very same qualities that differentiate a successful pre-med from an unsuccessful pre-med, so hey, you’re already ahead of the game!

Look forward to all the great opportunities that have presented themselves throughout this application process and take advantage of them in your upcoming undergraduate career.

Program Cost

The cost of a BS/MD program is essentially the same as a regular undergrad to med school track. It’s not necessarily cheaper unless you do an accelerated program (i.e., a 6- or 7-year BS/MD program) rather than an 8-year option.

For that reason, accelerated programs are worth considering if you can handle the condensed workload. Graduating and entering the workforce sooner means less debt and an earlier start to pay off those student loans if you had any.

Smaller but still noteworthy savings come in the form of bypassing the med school application program, since BS/MD programs offer conditional acceptance to medical school. Application fees to multiple programs and other expenses associated with travel and board can add up to thousands of dollars, fast.

BS/MD Programs in the United States

The following is a list of all available BS/MD programs and similar baccalaureate-MD programs in the United States as of December 2023.

Program NameMCAT Required?StateProgram LengthMinimum GPAMinimum Test Scores
University of Alabama/UAB School of MedicineNoAL8 years3.6 
University of Arizona / College of Medicine -TucsonNoAZ7 to 8 years  
California Northstate University/CNU College of MedicineYes, 510 or higher required for priority interviewCA7 to 8 years  
University of Colorado Denver/ University of Colorado School of MedicineNoCO8 years3.5

ACT 27

SAT 1185 (Evidenced-Based Reading, and Writing + Math)

University of Connecticut/ UConn School of MedicineYes, minimum score in 80th percentile rank; no subtest scores below 55th percentile rankCT8 years3.6 
Florida Atlantic University/ The Schmidt College of MedicineNoFL7 to 8 years4.3 (Weighted)

ACT 33

SAT 1490

Florida International University/ Herbert Wertheim College of MedicineNot SpecifiedFL7 Years3.7

ACT 31

SAT 1350

Augusta University/Medical College of GeorgiaYesGA7 to 8 years3.7

ACT 32

SAT 1450

University of Illinois Chicago Guaranteed Professional ProgramYesIL8 years ACT 28
Indiana State University/Indiana University School of Medicine (open to residents of rural Indiana only)Yes, minimum score must meat the mean score of the previous year’s matriculantsIN8 years3.5

ACT 27

SAT 1270 (Evidenced-Based Reading, and Writing + Math)

University of Evansville/IU School of Medicine EvansvilleYesIN8 years4

ACT 29

SAT 1360

Grambling State University/Meharry Medical College (open to Black/African-American students only)Yes, score must meet the current minimum MCAT score (changes yearly)LA7 to 8 years3.25 
Wayne State University/ Wayne State School of MedicineYes, Successfully complete the MCAT with a score no less than the 70th percentileMI8 years3.5

ACT 28

SAT 1310

Missouri Southern State University/Kansas City UniversityNoMO7 years3.7

ACT 28

SAT 1310

St. Louis University/SLU School of Medicine (does not offer guaranteed admission to the school of medicine but does increase chances of acceptance)Yes, a score of at least 508 must be achieved.MO8 years  
University of Missouri-Kansas City/UMKC School of MedicineNoMO6 years 

ACT 24

SAT 1160

Caldwell University/Rutgers New Jersey Medical SchoolYes, students must receive a competitive scoreNJ7 years3.5SAT 1470 (Critical Reading and Math)
Caldwell University/St. George’s UniversityNoNJ7 years3.5SAT 1270
The College of New Jersey/Rutgers New Jersey Medical SchoolYes, no minimum score requiredNJ7 years3.8

ACT 30

SAT 1400 (Evidence-Based Reading & Writing, and Math sections)

Drew University/Rutgers New Jersey Medical SchoolYes, no minimum score requiredNJ7 years3.8

ACT 34

SAT 1500 (Verbal and Math)

Monmouth University/St. George’s University School of MedicineYesNJ8 years3.4ACT 30
Montclair University/Rutgers New Jersey Medical SchoolYes, students must receive a competitive scoreNJ8 years3SAT 1100 (Evidenced-Based Reading, and Writing + Math)
New Jersey Institute of Technology/Rutgers New Jersey Medical SchoolYes, students must receive a competitive scoreNJ7 years3.6

ACT 33

SAT 1490

Rowan University/Cooper Medical SchoolYesNJ7 years  
Rutgers University/Rutgers New Jersey Medical SchoolYes, students must receive a competitive scoreNJ7 years 

ACT 32

SAT 1400 (Evidenced-Based Reading, and Writing + Math)

University of New Mexico School/ University of New Mexico School of MedicineYesNM8 years 

ACT – Math 22, Reading 19, Science 19, English 19

SAT – Math 540, Reading 410

Albany College of Pharmacy and Health Sciences/ SUNY Upstate Medical UniversityNoNY 90% average minimum

ACT 31

SAT 1360

Brooklyn College/SUNY Downstate College of MedicineYes, a minimum score of 509NY8 years  
The City College of New York/CUNY School of MedicineNoNY7 years  
Hofstra University/Donald and Barbara Zucker School of Medicine (for underrepresented in medicine (URM) and economically disadvantaged pre-med students)Yes, a score equivalent to or greater than the 80th percentile at the first sitting must be achievedNY8 years3.7

ACT 32

SAT 1410 (Evidenced-Based Reading, and Writing + Math)

Purchase College/ SUNY Upstate Medical UniversityNoNY 90% average minimum

ACT 25

SAT 1200

Rensselaer Polytechnic Institute/Albany Medical CollegeNoNY7 years3.5

ACT (No minimum)

SAT (No minimum)

Siena College/Albany Medical CollegeNoNY8 years 

ACT 30

SAT 1360

St. Bonaventure University/George Washington University School of MedicineYesNY8 years3.6

ACT 30

SAT 1390

(Evidenced-Based Reading, and Writing + Math)

Stony Brook UniversityYesNY8 years3.8SAT 1490
SUNY Polytechnic Institute, SUNY College of Environmental Science and Forestry/ SUNY Upstate Medical University College of MedicineNoNY8 years3.5

ACT 25

SAT 1200

Syracuse University/ SUNY Upstate Medical UniversityNoNY8 years3.5

ACT 29

SAT 1360

Union College/Albany Medical CollegeNoNY8 years 

ACT 30

SAT 1410

University at Albany/ SUNY Upstate Medical UniversityNoNY8 years90% average minimum

ACT 29

SAT 1360

University of Rochester/ University of Rochester School of Medicine and DentistryNoNY8 years  
Case Western Reserve University/Case Western Reserve’s School of MedicineNoOH8 years  
University of Cincinnati/University of Cincinnati School of MedicineYesOH8 years3.5

ACT 29

SAT 1300 (excluding writing portion)

University of Toledo/University of Toledo College of Medicine and Life Sciences (guaranteed medical school interview if requirements are met; not a guaranteed acceptance)Yes, a score in the 65th percentile or greater guarantees an interviewOH7, 8, or 9 years3.5

ACT 28

SAT 1310

The University of Oklahoma/ University of Oklahoma College of MedicineYes, a score equal to or higher than the averageOK7 to 8 years  
University of Tulsa/ University of Oklahoma College of MedicineYes, achieve a score that matches the average result achieved by incoming enrollees.OK8 years4Typically a score in the top 5% on either test.
Drexel University/Drexel University College of MedicineYes, a score of 511 or a total of 513 with no section score less than 127PA8 years3.5

ACT 32

SAT 1420

Penn State/Sidney Kimmel Medical CollegeYes, a score of 508 or morePA7 years  
Temple University/Lewis Katz School of MedicineNot SpecifiedPA7 years 

ACT 28

SAT 1273 (Verbal and Math)

University of Pittsburgh/University of Pittsburgh School of MedicineOnly required if student is accepted without an SAT or ACT score, score is only used for advising (not admission) purposesPA8 years 

ACT 34

SAT 1490

Brown University/Warren Alpert Medical SchoolNoRI8 years  
Baylor University/Baylor College of MedicineNoTX8 years3.7

ACT 32

SAT 1430

Texas Tech University/ Texas Tech University Health Sciences Center School of MedicineNoTX8 years 

ACT 30

SAT 1360

George Washington University/GW School of Medicine and Health SciencesNo, but they do require an MCAT practice exam scoreWashington, D.C.7 to 8 years  
Howard University College of MedicineYes, 504 minimum requiredWashington, D.C.6 years3.5

ACT 28

SAT 1300

 

FAQs

A BA/MD program is designed for students to receive a Bachelor of Arts degree, while a BS/MD program involves a Bachelor of Science degree.

BS/MD programs are designed for high school seniors to apply for a dual-degree program spanning their entire undergraduate and medical education. 

Early decision programs (EDPs) allow med school applicants (in undergrad or beyond) to select a single medical program in exchange for early, guaranteed acceptance. These choices are binding — if you apply EDP, you may not apply anywhere else unless your EDP application is rejected.

Early assurance programs (EAPs) are programs in which pre-screened applicants may be offered the opportunity for early acceptance by specific medical colleges. Unlike EDPs, these are restricted to include only students invited by an institution (any student may not simply apply via early assurance). 

Similar to BS/MD programs, EAPs are very competitive with just a few spots available at any given medical institution each year.

I haven’t heard anyone complain that they had a harder time studying for the USMLE because they entered a BS/MD program that didn’t require taking the MCAT.  

Even though some BS/MD students don’t have to take the MCAT, they have learned all the same material and undergone the same classroom testing needed to prepare for the USMLE. 

Additionally, it seems that BS/MD students place successfully into their top residency choices just as often as their classmates. Even if they were at a slight disadvantage with USMLE preparation, it doesn’t seem to impact their career in any way.

The concern of being locked into a particular medical school is legitimate and varies on a school-to-school basis. Some schools, like the University of Rochester, have no problems with you applying to other med schools.

If you choose to take the MCAT, fill out the AMCAS application for other schools, and get into another medical school that is perhaps better suited for you, then by all means you have the right to leave.

During that process, though, some schools like the University of Rochester School of Medicine, will continue to reserve a spot for you.

Other programs, however, might take away your reserved spot if you choose to apply out and will then require you to apply directly to the medical school to gain admission (of which there is no guarantee of being accepted).

Still, other schools will offer contingencies on this unique situation; for example, if they don’t require their program students to take the MCAT and you choose to do so to apply elsewhere. In this case, the program will require you to achieve a minimum score to keep your spot reserved.

The best way to find your answer is, again, to ask questions during the interview process and decide in the end what is of greater importance to you: flexibility of choice or certainty of admission to med school.

No, an accelerated program will not put you at a disadvantage for med school. In contrast, students often say that accelerated programs are better because you have less time to forget the material you just learned. 

And if you think about this logically, it makes sense. Information that you learn in one science class is generally going to be applied in some other science course that you eventually take. 

Now, if you take the first class one year and the second class the following year, then you are more likely to have forgotten the material you learned in the first class than if you had taken the two classes within a period of a few months.

Similarly, students often claim that summer classes are better for learning material than regular semester classes simply because you have class every single day in the summer. It’s easier to remember exactly what you learned in the last lecture and build upon it.

In an accelerated program, this is exactly what you do; you take more classes during the summer, and you take related science classes within a shorter time. There is no reason why you’d be at a disadvantage; if anything, you probably know the information better!

Also, keep in mind that most accelerated programs offer you the chance to delay your entry into medical school by a year or so if you feel the program’s pace is too fast. 

Accelerated programs are meant for students who want to finish their medical training as quickly as possible. But if somewhere along the line you decide to change your mind on that, then most programs are flexible with it.

While a BS/MD program doesn’t necessarily lock you into one career path, most people who choose this route do so because they want to be locked into a medical career path.

Many students choose to pursue different majors (while simultaneously completing their pre-med coursework).

I personally know someone who kept up all his pre-med requirements while pursuing an economics degree. At the end of his senior year, he decided to drop the idea of going to medical school and instead went to Wall Street.

With accelerated programs, it can be slightly more difficult to pursue non-science majors since you’re expected to complete a set number of science classes in a limited amount of time, but it’s not impossible to do. 

The purpose of BS/MD programs is to offer you a less-pressured, more guaranteed route to medical school. But if you end up deciding that this isn’t the right path for you, there is no contract agreement binding you to it. The choice is always yours to change your direction in life.

The Program in Liberal Medical Education (PLME) is an 8-year program within Brown University that integrates undergraduate and medical school education. Students pursuing the PLME can specialize in either sciences or humanities.

Next Steps

Hopefully, you have gained more perspective in terms of what to expect and what not to expect if you choose to commit to a BS/MD combined program.
Ready to make your dreams of becoming a doctor a reality? The next best step is to speak with a member of our enrollment team who can help you get into a competitive direct medical program. 70% of our students get an acceptance!
Kachiu Lee, MD

Kachiu Lee, MD

Dr. Lee specializes in BS/MD admissions. She was accepted into seven combined bachelor-medical degree programs. She graduated Summa Cum Laude from Northwestern University and proceeded to Northwestern University’s Feinberg School of Medicine in Chicago, IL. After completing a dermatology residency at Brown University, Dr. Lee pursued a fellowship in Photomedicine, Lasers, and Cosmetics at Massachusetts General Hospital and was a Clinical Fellow at Harvard Medical School. Academically, she has over 100 peer-reviewed publications and lectures internationally.

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