We spoke with four admissions officers to understand what it means if you've been placed on a waitlist or alternate list.
Yvette Perry, PhD
Associate Dean for Admissions and Strategic Enrollment
College of Medicine and Life Sciences
University of Toledo
Leila Harrison, PhD, MA, MEd
Vice Dean for Admissions, Student Affairs, and Alumni Engagement
Elson S. Floyd College of Medicine
Washington State University
Judianne Kellaway, MD, MEd, FACS
Associate Dean for Admissions and Outreach
Joe R. and Teresa Lozano Long School of Medicine
University of Texas Health Science Center at San Antonio
Liesel Copeland, PhD
Director of Admissions and Medical Education
Robert Wood Johnson Medical School
What does it mean when you’ve been placed on a waitlist by a medical school?
Medical schools have a set number of seats in their class and cannot admit above this number without approval from several sources, including the national accrediting body [in this case, the Liaison Committee on Medical Education (LCME)]. Medical schools typically interview many more candidates than they have space for given that some candidates are accepted to multiple medical schools. Being placed on a waitlist (also referred to as an “alternate list”) at a medical school means that you are not offered an immediate spot in the class, but you are still in consideration and may be offered a spot later should accepted applicants (or others on the waitlist) choose to withdraw or not accept an offer from the school. Yvette Perry, PhD, associate dean for admissions and strategic enrollment at the University of Toledo College of Medicine and Life Sciences, shared, “we reject very few interviewed candidates outright, so almost all candidates who we do not extend an offer to are placed on our alternate list. By the time a candidate gets past the interview stage, many of them will be highly qualified candidates for our program. In fact, though these decisions are made by our admissions committee, and I do not personally vote, as the admissions dean I am blown away by the majority of candidates we interview and often wish there were a way to admit everybody!”
Judianne Kellaway, MD, MEd, FACS, associate dean for admissions and outreach at the University of Texas Health Science Center San Antonio Joe R. and Teresa Lozano Long School of Medicine, agrees, stating, “The most important thing we would want an applicant to know is this: we all realize that this process produces a tremendous amount of stress and anxiety for applicants and those supporting them (e.g., family and advisors). You may know people who’ve already been accepted, and it can feel isolating and worrisome. If we could only give one piece of advice, it would be to hold that dream in front of you and stay positive. You’ve done your best, and that is all you can do — for now. Try to actively engage in some positive thinking and stress reducers in this period. Do not dwell on other people’s stories or pathways. This journey is yours alone and you can — you will — make the best of it. So, hang in there.”
Periodically throughout the cycle, usually starting in early May (although this may vary by school), admissions committees review the accepted and alternate list pools and communicate with candidates who aren’t likely to be admitted so that they can begin enacting their parallel plans.
Are there any policies you must agree to while on the list?
Policies will vary by medical school and will vary depending on timing during the cycle. Generally, the email or other communication that you receive notifying you of your waitlist status will include additional information about that school’s policies. You will also receive communication throughout the process from ACMAS’ Choose Your Medical School tool. It is very important to follow these policies and deadlines. Note that these policies are also visible in the Medical School Admission Requirements™ (MSAR®) school profiles.
How likely is it to come off the waitlist?
There are many factors contributing to whether a candidate will be accepted from the waitlist. A school may have a ranked waitlist, a non-ranked waitlist, or employ a hybrid system that includes rankings and other considerations. (For more on this, see information provided about waitlists in each MSAR school profile.) “Some schools may have tiered alternate lists (e.g., waitlist and high-priority waitlist) so they may be able to provide estimates of movement that differ depending on the tier,” shared Leila Harrison (née Diaz), PhD, MA, MEd, vice dean for admissions, student affairs, and alumni engagement at Washington State University Elson S. Floyd College of Medicine.
But even with these different waitlist systems, the likelihood of anyone being accepted from the waitlist depends on a multitude of factors within the applicant pool in any given year. For example, for a school with a ranked waitlist during one cycle, there may be many accepted candidates who decline an offer leading to an offer to the 30th person on the waitlist. The following year at that same medical school, there may be very little movement from the accepted pool such that someone who is 12th on the waitlist is not made an offer. “At Toledo, we have a hybrid-ranked alternate list," Perry explained. “Within broad groupings of admissions committee evaluation scores, we may prioritize extending acceptances to students based on mission-based criteria such as Ohio/Northwest Ohio residency or status as a current student in our postbaccalaureate program. In some years we have matriculated dozens of students from the alternate list, while in other years, fewer than five. Though each year we carefully analyze our own local historical data as well as national data over several years, it is still challenging for us to anticipate how any given admissions cycle is going to go with regard to alternate list matriculation.” However, Kellaway explained that there is a point for those applying through the Texas Medical and Dental Schools Application Services (TMDSAS) when “waitlist movement is most predictable at certain points: following the April 30th deadline to narrow down to one seat nationally and following the Texas Match system.”
Is there anything you can do to improve your ranking on the list and/or be admitted?
As frustrating as it is to hear, the answer is that it will vary depending on the medical school. Some schools conduct an additional holistic review process at the waitlist stage, so additional updates from you about activities and accomplishments may help if the school allows these. Other schools only use the decisions and scores from the admissions committee during the initial evaluation stage, so additional information from you is not likely to have any impact or allowed. It is important that you familiarize yourself with the school’s policies and follow them exactly. For example, if a school accepts update letters, but only if they are uploaded to a secondary application portal, do not email updates to the admissions office. These policies are typically shared with applicants when they are notified that they have been placed on the alternate list.
Two important things for waitlisted candidates to do:
- Make sure your contact information on file with the school is up to date.
- Be ready to respond immediately to requests for documentation or other actions.
“What I would suggest you be cautious about is attempting to influence the waitlist process by having family members, alumni of the medical school, important people you know, etc. contact the admissions office, the dean, or other people at the school outside of a formal process,” warned Perry. “This is a suggestion I often see on blogs and other sources, but some medical schools, including Toledo, do not welcome this kind of ‘side door’ communication because of equity concerns.” When you submit your application, you have the opportunity to have letters of recommendation submitted on your behalf. This is where you should include support from people who can speak to your candidacy. While some schools may allow additional letters through a formal submission process, again, be sure to confirm details in a schools’ notification to you or on their website. If you have any doubts, ask the school directly before proceeding.
Any attempts by candidates and their supporters to influence the process via political or financial pressure will be a huge ethical red flag. Additionally, the LCME expressly forbids schools from making admissions decisions (from the waitlist or otherwise) based on these factors. “I also discourage waitlisted candidates from paying a service or individuals who claim to be able to get you off a waitlist,” further warned Perry. “This is probably going to be a waste of your money because there is likely nothing that such a third party will be able to do to impact a school’s process and procedures.”
Is a waitlist ranking in one cycle taken into consideration in future application cycles?
This is another example of a policy that varies from school to school. For instance, the University of Toledo College of Medicine welcomes reapplicants from previous years and they are not penalized. However, they consider each admissions cycle separately and aren’t likely to consider someone’s ranking from a previous year in a subsequent cycle. If a student previously applied but was not accepted through their postbaccalaureate program or one of the early assurance programs, they do make an effort to review the candidate as early as possible in the cycle for potential interview invitations. But even in this case, these students’ admissions scores or rankings from previous cycles do not influence admissions decisions in later cycles.
“For medical schools, reapplicants are often viewed in the same way as a new applicant in any cycle,” explained Harrison. “Schools will want to see continued life experiences that indicate a person is living a life geared toward medicine. Are you contributing to the community (or have you simply checked it off the ‘list?’)? Are you learning about health and research?” For nontraditional applicants — including those with their own families or a career outside of medicine — making time for additional experiences may be difficult, but sustained, demonstrated motivation toward medicine is important.
Some applicants ask about sending in a letter affirming their interest or sending updated information or experiences. Is this advisable?
Most medical schools will let you know if additional information like letters of interest or updates are allowed, at what point in the cycle they may be submitted, and how they should be submitted. If updates are allowed, Perry suggested making this communication as brief as possible. “Probably attaching a 10-page, recently published journal article will not be appropriate! It is also wise to make sure the update adds significant new information to your file. For our medical school, letters of intent rarely provide us with any certain, actionable information such that they would sway our admissions decisions. One exception may be if there is some new information or situation that sheds light on a candidate’s commitment to attend. For example, there may be a situation in which someone’s partner was recently accepted into graduate school at the same institution, making the medical school the candidate’s top choice.”
If you’re allowed to submit a letter of intent or interest, above all else, be honest. For example, don’t send letters to three schools telling each they are your top choice. Also, show the same attention to detail in this communication that you would for all other aspects of your application. “It may seem obvious,” Perry shared, “but I am surprised every year that we receive multiple emails stating that we are a candidate’s top choice where it is apparent from multiple font sizes and text styles that the candidate has just dropped our institution’s name into a form email. Occasionally, we even receive emails with another medical school’s name accidently in the email body or with multiple schools’ email addresses clearly visible in the ‘to’ field of the email.”
Most schools will tell you that by the time an applicant sends a letter of interest, the formal evaluation process has been completed, so there is likely little influence of such a letter. Some medical schools allow applicants to provide updates to their application materials, while others do not allow any updates or letters of intent or interest. “We want to ensure all applicants are assessed using the same official application materials; therefore, we do not accept any outside updates or letters of interest/intent to ensure equity,” said Harrison. Kellaway went further to share that, “your letters of interest or intent should be honest and limited. It can be helpful for a school to know that you are still considering them, and so reaching out promptly with a withdrawal or vice versa a note that says you would like to remain on the alternate list in April can ensure clear communication.”
If you’re accepted, what happens next? How much time do you have to decide?
Typically, this depends on when you’re offered a spot in the class from the alternate list and how soon the school’s orientation begins. Pay close attention to the information and deadlines that the medical school provides to you. If you’re unable to meet the response deadlines, communicate this in a professional and timely manner to the admissions office. “In the case of our program,” Perry shared, “it is not uncommon for us to provide an accepted student an additional day or two to give them time to discuss options with a partner, weigh financial aid packages, or other reasons.”
Timely communication is key — the worst thing you can do is be unresponsive. During this time, admissions offices are extremely busy working to fill their medical school class and may move to the next candidate on the alternate list if they do not hear from you.
What if you don’t come off of the list? Should you reapply to the school again?
Some medical schools provide reapplication information in their final notification to candidates remaining on the waitlist at the close of the cycle. They may also share other important information, such as whether the school offers feedback to candidates who were not accepted. However, it is important to recognize that you may only receive general information — or even no information — about why you were not accepted.
The biggest reason why an applicant who made it to the interview stage is not accepted is due to an extremely large pool of highly qualified applicants and a limited number of available medical school seats. “I encourage people who are not accepted from the waitlist, as well as those who may not have received interviews, to take some time to consult resources and trusted advisors, reflect on your goals, and ultimately come to an intentional and informed decision regarding reapplication,” suggested Perry. “Because the close of each application cycle overlaps with the start of the next cycle, often candidates not admitted from a waitlist will immediately turn around to submit another application. While that may be wise for some, I believe for other people this may be a mistake.” When reapplying to schools — in particular, to institutions you’ve previously applied to — it is important to show growth and experience. It is a mistake to apply again with the exact same application. Schools that have reviewed your application previously will be scrutinizing the submission to see what steps you’ve taken to become a stronger and more competitive applicant, especially if you’ve received feedback on your previous application.
Many medical schools provide application presentations and workshops in the spring. Some also offer advising sessions to assist in reapplying. “Do not wait until only months before the next cycle opens to improve yourself and/or your experiences,” said Harrison. “Even if you are being interviewed, acceptances are not guaranteed, so you want to continue to seek improvement.”