Secondary Medical School Applications Place an Unfair Financial Burden on Middle- and Lower-Income Applicants : Academic Medicine

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Student and Resident Letters to the Editor: Admissions, Assessment, and Advocacy

Secondary Medical School Applications Place an Unfair Financial Burden on Middle- and Lower-Income Applicants

Ghaffari Rafi, Arash

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Academic Medicine 92(6):p 728, June 2017. | DOI: 10.1097/ACM.0000000000001694
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To the Editor:

Although physicians strive to promote social justice, after applying to medical school, I came to find that, ironically, the admissions process seemed to oppose social equality.

To apply, students pay $160 for the American Medical College Application Service (AMCAS) processing fee, $38 for every school applied to, and secondary applications and fees (which quickly begin to pile onto the overall cost).

The process of distributing secondary applications and fees is, in my opinion, the greatest fault in the system. Medical schools should not send these “secondaries” to students who are uncompetitive at the particular institution. Although the applicant bears the responsibility to apply appropriately, for many applicants, the idea of holistic review conjures hope. Yet many medical schools that employ holistic review do not adequately screen applicants via the primary application; these institutions send the secondary application to all applicants and require that they pay a secondary fee (ranging up to $150). For instance, one colleague had a primary application verified on July 20, 2016; received an unscreened request for a secondary application on July 22; submitted a $100 fee with the secondary on July 25; and, three weeks later, was rejected.

Schools should abolish admissions policies in which secondary fees are requested before an application is legitimately screened. Sending secondaries and then receiving rapid rejections leaves applicants dejected and feeling taken advantage of.

One solution to the process would be for institutions to adopt a similar policy to that of Vanderbilt University, where secondaries are sent only to roughly one-third of the applicant pool, and only after “three faculty members provide an independent, holistic review of the AMCAS application.”1

Sending unscreened secondaries is most harmful to middle- and low-income families who do not qualify for fee assistance programs. The costs of applications place an incredible strain on these students’ finances, to the point that some students take out private loans to cover the cost of applying to medical school. Affluent students can submit more secondaries, and can thus afford to risk paying for an inadequately screened application.

With 48% to 51% of medical students coming from families whose incomes are in the top quintile,2 the disparity between these students and those who are financially restricted is only exacerbated by unscreened secondaries when financially restricted students can only submit limited secondaries.

Arash Ghaffari Rafi
Second-year medical student, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii; [email protected]


1. Vanderbilt University School of Medicine Office of Enrolment Services. AMCAS application. Accessed February 21, 2017.
2. Jolly PDiversity of U.S. medical students by parental income. AAMC Analysis in Brief. January 2008;8(1). Accessed February 28, 2017.
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