In “The Slow Boat to Tenure” I noted that 2025 was my “De Morgan year”–I turned “the age X in the year X squared.” Serendipitous, that this mathematical curiosity should coincide with my reaching tenured faculty status at Florida Tech! Auspicious as the timing was, however, this promotion was not my household’s most significant event of 2025.
The most significant event in my household last year was my wife‘s admission to medical school.
Then why is this the first we’re hearing about it?
Well, once the decision had been made to go this route, I may have said to my wife, “You know, we have the opportunity to do the funniest thing…“
we announced Aprilynne’s plans by posting first day of school pictures on social media, which you may already know since that is probably how you got here
Of course you did. How did she make this decision in the first place?
That’s a surprisingly involved question. When I met Aprilynne in the Year of Our Lord 1999, she was on a Pre-Med pathway at Lewis-Clark State College (presently in talks to become Lewis-Clark State University). Her father spent most of his career working in hospitals as a radiology technologist, leading Aprilynne, at some point in her childhood, to decide to become an obstetrician. At 18 years old that was still her plan. Soon after meeting me she changed her major to Creative Writing (at the time, a B.A. rather than a B.F.A.) for reasons she has briefly mentioned elsewhere. Even so, before becoming a published novelist, Aprilynne got certified as a doula and childbirth educator and spent many years working with pregnant and delivering mothers in an adjunct support capacity. You can also see her fascination with biology and medicine woven through her novels–for example, she worked a lot of biochemistry and virology into the Earthbound trilogy, and several of her characters go on to become physicians and scientists as adults.
So in some ways, the decision had long since been made; reality just took its sweet time catching up. Aprilynne’s publishing career supported me through nine years of graduate school, during which time we occasionally discussed the possibility of her doing graduate work as well. But the timing never seemed quite right–she was busy with writing, I was busy with school, we had young children to raise, we had other things to do. That particular door seemed closed to her, and no one was especially put out about it. Life is too short to do everything; at some point we all have to prioritize!
Nevertheless, in 2024, Aprilynne took a remote position as a Senior Marketing and Content Specialist for vRad–a teleradiology practice. It was kind of a unique position in that most of the marketing she wrote was not to customers, but to potential employees–physicians vRad wanted to recruit. As a professional storyteller with an unusually keen interest in medicine, she was exactly what the vRad marketing team needed to hone that particular pitch.
And then, dear reader, she went and swallowed her own press. On 24 April 2024, Aprilynne and I had the following exchange via SMS:
this text cost me $600,000
This is not a response I could have given for most of our marriage (now in its 25th year!). Although two of our children are college graduates and a third is a cadet at the Citadel, we do still have one teenage daughter living at home. My job is not portable and we have always prioritized stability for our children above our career aspirations. As anyone who has ever seriously applied for graduate school can tell you, you should apply broadly and be prepared to move house. Being bound by geography hurts your odds of admission: you have to depend on getting a “yes” from your local school, and that’s assuming you even have a local school!
In April of 2024, there was no medical school in Brevard County, Florida–there was, strictly speaking, nowhere for Aprilynne to apply.
But we happened to know that the Burrell College of Osteopathic Medicine (now the School of Osteopathic Medicine of the Burrell College of Health Sciences) was planning to open a satellite campus at Florida Tech that very August. This was fortuitous. Financially speaking (see below), each additional year of delay made medical school a less financially plausible choice, so the above response is also not one I would have been able to give, say, five years from then–which is about what we would have had to wait, if we had to relocate for her to go to medical school.
(Apologies for the complex temporal structure of that last sentence. It’s probably easier to parse if you’ve played Continuum, or are in fact a time traveler.)
Point is, the timing was unexpectedly good–remarkably needle-threading, really. I figured it was probably too late for Aprilynne to apply to the inaugural class, but surely she could take the MCAT and start in 2025?
Wait–it’s not just the MCAT, though. Isn’t there also, like, a mountain of prerequisite coursework for medical school?
I’m impressed you know that! I certainly didn’t. Aprilynne had a rough idea and, after confirming the details online, suggested that this might be a half-baked idea after all. Despite having completed her B.A. in 2002, in order to matriculate at Burrell Aprilynne would first need to complete:
- 8 semester hours: Biology (with Lab)
- 8 semester hours: General/Inorganic Chemistry (with Lab)
- 8 semester hours: Organic Chemistry (with Lab)
- 8 semester hours: Physics (with Lab)
- 3 semester hours: Science Elective
A single full-time undergraduate semester is standardly 12 to 18 credit hours, with rarely more than one or two lab sciences scheduled per semester. Aprilynne could take the courses at Florida Tech on my faculty discount, but cramming 35 semester hours of lab science into a single year would be a heavy lift even if she wasn’t working full time, which she was. Furthermore, the MCAT is not a simple, broadly subject-generic psychometric like the SAT, GRE, or LSAT–it is in substantial measure a genuine subject-matter exam for which lab sciences are a key preparation. She would need to be at least most of the way through this coursework before she could sit for the MCAT. Forget daunting, it simply couldn’t be done in a single year. It seemed absurd even to try to get it done in two, and much more than that would, as noted, foil the plan entirely.
So Aprilynne nearly decided to scuttle the idea there. But I didn’t spend nine years in graduate school and become a university professor without learning a few tricks of the trade (that is to say, Google-fu). With a little digging, I discovered that the University of New England has a “Science Prerequisites for Health Professions” program offering self-paced, at-home lab science courses. Not the cheapest option (the final price tag was a hair over $20,000), but certainly the fastest–pending student ability and work ethic! Aprilynne verified that Burrell would accept these credits (most medical schools do, though you will not be surprised to hear that some schools are quite unreasonably snobby about this sort of thing). Then she figured that, absurd or no, if she could complete one class every eight weeks, she could get through enough of the curriculum to plausibly sit for the MCAT in one year. While completing the whole sequence might improve her MCAT score a little, she decided she could finish the second semesters of Physics and Organic Chemistry at a more leisurely pace during “application season,” i.e. the year after taking her MCAT.
Besides, I told her, she could pull the ripcord at any time. One class is not a commitment, it’s just a toe in the water.
Aprilynne started her first section of Biology (with Lab) in May of 2024. For the next year, her schedule was basically work, school, family, sleep. She didn’t watch TV or movies, read or write any novels, or even go out on her paddle board, there simply wasn’t time.
she and i did reach level 50 in pokemon go before the cap increase, but that’s a game we play between important things
It probably helped that Aprilynne was (mostly) having fun with her coursework anyway. Often, as she progressed, she would regale me with bits of knowledge and insight she found particularly interesting. As a professional educator, I have observed that “non-traditional” college students are almost always the best students I have. They are heavily self-selected, but (as a result) also very deliberately engaged. They have a sense of purpose and direction that teenagers and twenty-somethings often lack, and this colors every interaction they have with the material and with their instructors. They’re not checking boxes or marking time, they’re actively learning. Aggressively learning, even. I could see that Aprilynne was really absorbing the material and enjoying the process, especially when it plausibly related back to medicine.
(We did also laugh about pregnancy making her smarter; further inquiry into the plausibility of the proposition I leave as an exercise to the reader!)
Aside from a small break to focus on MCAT prep (mostly, practice exams) in 2025, Aprilynne remained continuously enrolled in UNE courses until she completed her final prerequisite earlier this year. Despite jumping headfirst into challenging coursework after a 22 year break from formal education, she completed her speed-run of undergraduate science as a straight-A student. Then she did very well on the MCAT, significantly above what she needed for admission, which is historically a pretty good predictor of both success in medical school and in medical practice. That strengthened our confidence that this was a plausible vocational path and long term plan. Plus, she got a nice little scholarship acknowledging her performance.
…do medical schools even accept non-traditional students?
Mostly, yes! Though the usual definition of a “non-traditional” student in medical school is “over the age of 24 and/or has spent more than two years away from undergraduate work,” which is a pretty big group of comparatively young people. Only about 3.5% of medical students matriculate over the age of 30, and roughly 0.3% of medical students matriculate over the age of 40. I’d say “this year my wife finally entered the 1%” but as a #1 New York Times bestselling author and the recipient of a pacemaker in her early 40s (but those, as they say, are other stories), my wife is no stranger to unusual events or rarefied achievements.
(But rarer cases exist! In American medical schools, there are about a dozen total matriculants over the age of 50 each year. Aprilynne should be done with school, albeit still in residency, before she turns 50.)
Well, the anticipated ROI is bound to get tricky at that age, right? Not to be indelicate, but, isn’t medical school an expensive choice?
On one hand, yes. On the other hand–less than you might think! The tuition at some in-state public programs runs less than $30,000 per year, and even in the wake of the “Big Beautiful Bill” the federal government will loan you up to $50,000 per year for medical school. So in theory, medical school can be cheaper than some undergraduate programs! In theory–and it helps, as discussed, to apply broadly.
Alas, our local option, Burrell, is a private, for-profit D.O. school, with tuition and fees currently approaching $75,000 per year, and certainly not including the cost of living. Fortunately I’ve got the cost of living more or less covered, so figure a sticker price of $300,000, plus interest, plus opportunity costs (mostly, Aprilynne’s earning potential), and yes, I’ll be honest, it’s a significant investment with a nontrivial fiscal horizon. She’s currently leaning toward radiology, though she hasn’t ruled out obstetrics, emergency medicine, or family practice, which reflects a pretty wide range of possible salaries. Regardless of where she lands, though, our low-end projections put us at “break-even” on the whole undertaking by 2040. Mid-range projections hit break-even around 2037.
So, roughly a ten year project, give or take, after which the upside is pretty generous. Neither of us intends to retire before 2050, and we’ll both be in careers where septuagenarians are common, so our anticipated ROI is comfortable. Far less than it would be for matriculants in their mid-twenties, of course! But matriculants in their mid-twenties haven’t generally got real estate, IRAs, and grown children, either. Worst case scenario (short of catastrophes), we could sell our house to pay off the whole endeavor and be left with nothing but a healthy retirement savings, four adult children, three doctorates, zero debt, and two comfortable careers between us. Not the worst place to be “starting over” from, I figure–and I really don’t expect to have to implement “plan: starting over.”
(It’s just that the time to make contingency plans is before you need them!)
And really, the money is largely beside the point. Anticipated physician income makes the requisite debt assumption fiscally plausible given our timeline, but the real driver of the conversation is that Aprilynne has always been keenly interested in medicine and just couldn’t realistically pursue it until now–and every additional year she might have waited would have reduced the fiscal plausibility by a meaningful margin. She had long figured that door was closed. The moment it cracked open, well, she was quick to stick a foot in the jamb.
What about the ROI to the profession? Should medical schools prioritize young matriculants for maximum community benefit?
It is certainly… interesting… to see what sorts of matriculants medical schools tend to prioritize–but that’s my professional hobby horse, not Aprilynne’s. One thing we learned, as we made our way through this process, is that about 40% of female physicians either transition to part-time work or leave medicine entirely within six years of completing their training. (The comparative statistic for men appears at least somewhat contested; while most sources I could find peg it around 3% to 5%, some put it as high as 25%. But substantially lower than the female rate regardless.) The primary reason is predictably straightforward: a woman who goes directly from undergraduate studies to medical school will be about 30 years old when she completes her residency. Women who want to have and raise children face much more constrained timelines than men; biologically, the best and easiest time to be a mother is in your 20s or 30s. If you leave the profession mid-career, getting back into it often proves more difficult than starting in the first place. There are surely ways in which the medical profession–like probably all professions–could be more family-friendly and supportive of parenthood. Nevertheless, that is the world we live in: prioritizing young matriculants is in at least some cases probably not ideal, and may actually be a bad idea. Even before factoring in the, uh, youthful drama that so often attends the lives of young professionals–to say nothing of the wisdom and experience that older matriculants bring to the table!
So Aprilynne’s timeline compares quite favorably. The youngest of our four children will finish high school in 2029. Aprilynne should complete a residency in her early 50s. She intends to practice medicine full time for two decades at least, and knowing her she’ll probably push for three. She probably won’t practice for 40 whole years (hey, who knows), but how many physicians ever do? Conversely, she will not have the pressure of bearing and raising children interfere with her career at all. Three of our four children are adults, two of them already college graduates. We’re planning our “empty nest” years. We look forward to grandchildren, but that’s not a full time undertaking (and if for some tragic reason it were to become a full time undertaking, I’ve been a homemaker before and I could do it again–I’m quite good at frittering away managing my wife’s impressive earnings). In terms of expected stability and anticipated contributions to actual health care (since Aprilynne does not want to be a research scientist, she wants to be a practicing physician), my wife is actually a much safer community investment than many, perhaps most aspiring physicians.
Honestly, I wish I could say we’d planned things this way from the start!
…or did we plan things this way from the start?
there are not many photographs specifically of our 2001 wedding decor, but in this one our chosen palette is clearly visible: academic hood-lining colors “philosophy doctorate royal blue” and “medicine doctorate kelly green“
Whatever the case, in retrospect, marrying young and having children right away has really, really worked out for us. Aprilynne–who, I never tire of reminding people, became a #1 New York Times bestselling author at age 27–is now embarking on a socially beneficial, personally fulfilling, feature-complete “Act 2” of adulthood, and the timing couldn’t be better.
also, i will never not recycle this “joke“
Conversely, is there even that much of a future in medicine? What about AI? What if medicine gets nationally socialized? There are lots of ways you could assume a bunch of debt and then get rug-pulled on anticipated wages…
Let me start by answering your question with a question: how many physicians would you say have lost their jobs, or been unable to find work, as a result of the 1998 release of WebMD?
Of course, AI is arguably a very meaningful improvement on highly-developed search engines, but I think the question is still worth asking. In 2016, I fully expected that by 2025 I would be able to buy a fully autonomous self-driving car for a modest price. The technology has come a long way, and there are indeed a significant number of autonomous vehicles out there on the road… but as of today they still get a lot of help from humans, and I can’t yet buy my own true robo-chauffeur. So far, one thing AI is very good at is being extremely, persuasively wrong in ways that only a human with relevant expertise is likely to catch. Physicians have been using technology to ease their workload for as long as there have been physicians, and AI is no exception to the trend, with many physicians already relying on AI to streamline their practice. So AI might help to alleviate the continuing national shortage of physicians somewhat, but we’re still a long, long way from deploying Emergency Medical Holograms. Indeed, if AI ever replaces physicians entirely, it will likely already have replaced everyone else.
As for government interference, well, it’s always possible. While I also do not think a revolution in medical law is in any way impending, I suspect we’re far more likely to get socialized medicine (and corresponding weirdness in the regulation of practice) in the United States than to outright replace physicians with algorithms. It’s possible this could result in depressed physician wages, but it doesn’t seem very likely, and along the way there would be both warning and mitigation efforts.
Ultimately, these kinds of concern just aren’t especially pertinent to Aprilynne’s interest in medicine. There is a strange and seemingly growing trend today of people avoiding doing the things they want to do now, because they are afraid of what might happen in the future. Never mind “we’ll cross that bridge when we come to it,” people need to start saying “we’ll cross that bridge if we come to it!” Even if, at the end of this road, we are all living in fully-automated AI-subsidized luxury space communes, Aprilynne will still have done the thing. She’ll still have acquired the knowledge for herself.
You mentioned residency–isn’t that another “apply broadly” thing?
Indeed it is! Completing medical school makes one a doctor, but to become a physician calls for licensing, and licensing calls for “residency”–several years of supervised practice. The “match” process for residencies is a whole thing, which I will not attempt to explain here. Suffice it to say that, once medical school is done, there are more years of training ahead. This is training that comes with a (comparatively modest) salary, but demanding hours–and basically no geographic flexibility.
Almost certainly, Aprilynne will not be able to complete a residency in Brevard County. Probably our best case scenario, barring developments outside our control, is that she will need to rent a room in Orlando and come home (or have me over to “her place”) whenever she’s not on call. But it wouldn’t be terribly surprising if she ended up in some other state entirely, and we’ve discussed this at length. I lived on my own while teaching at BYU in the summer of 2017, so this isn’t our first rodeo. Indeed most of our two-year courtship was via handwritten letters, complete with postage stamps, so in an age of SMS and video chats this is not the sort of challenge we find daunting.
Crucially, Aprilynne will not start residency before the summer of 2030–by which time our youngest child should be a sophomore in college. The geographical constraints on her medical school “search” process will simply no longer apply when the time comes to pursue residency. (Perhaps she will rent a room from one of you!)
Has Aprilynne retired from publishing, then?
Well, strictly speaking, no–although the next thing she publishes is more likely to be a research paper than a novel. It has already been several years since she last released a book, because she has been busy with other things–including, of course, the aforementioned prerequisites for medical school. But also, publishing has always been an irregular and sometimes unpleasantly cutthroat business, and the rise of LLMs has not been a stabilizing development. In other words, there’s a lot more than just revivified vocational aspirations standing between you and Aprilynne’s next literary masterpiece.
For now, Aprilynne’s Wings series is still in print with HarperTeen, and we ink new sub-rights deals once or twice a year–though these days I personally handle most of Aprilynne’s agenting. We’ve reclaimed the rights on her other titles and I have made them available on Amazon &c., which was an interesting undertaking given my meager design abilities. Our best selling in-house print title, by far, is Arabesque, despite being available to read online for free. This follows a pattern we’ve seen with many authors writing for children and young adults: kids and teens get attached to a particular series more often than they get attached to a particular author. So while Wings remains perennially popular, the financial incentives for doing other work have proven comparatively low.
Of course, Aprilynne is forever grateful to her readers (as am I!). We often tell people that we live in the house that faeries built, which is surprisingly close to the honest truth. As far as I know, our house was in fact built by regular old humans, but we most certainly purchased it with faerie gold. We even have a photograph of the lighthouse hanging in a place of honor in our foyer (such as it is). Storytelling is an integral part of Aprilynne’s identity, so I wouldn’t be at all surprised to see more stories from her at some point in the future.
But certainly you should not expect any new fiction from Aprilynne in the near future.
So this is really happening? It’s not some elaborate prank?
Coincidentally enough, almost exactly 20 years after I started law school, yes: it’s really happening! At the outset of all this, I assured Aprilynne that she could pull the ripcord at any time. Once she’d concluded her employment with vRad, I had to change my tune. “You can’t quit now!” I said. She wrote that down and taped it to her desk. But the truth is, the writing was on the wall the moment that long-closed door cracked open again. She needs no reminders. Perhaps the only thing she has ever wanted more, was to have and raise children. Well, in the voice of Astrid Hofferson, “Good, but you’ve already done that.” As that chapter of Aprilynne’s story comes to a close, it would be altogether unlike my wife to rest even a single second before turning the page and starting a new one.
If you’re reading this (and haven’t hacked my blog to access my drafts…) then Aprilynne has already started medical school (orientation kicked off on July 13th). Surprise! We hope you are entertained by our antics. Apologies for the subterfuge–and thanks to the occasional secret-keeper who helped Aprilynne along the way (I won’t out you here in case you fear reprisal, but feel free to speak up if you like and I will sing your praises). We even managed to keep our own children in the dark for most of a year, though eventually they had to be enlisted to keep the conspiracy afloat. With the task well and truly begun, and the various excuses I’ve been feeding some of you for the past two years surely worn thin: now you know what we’ve been skulking around at. Jajang!
If you would like to watch Aprilynne’s “white coat” matriculation ceremony live, click here on July 18, 2026, at 10:00am Eastern. I assume this link will stay alive as a recording after the event, but if not, I’ll just remove it.