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Letters to the Editor

“Holistic Admissions” During a Pandemic: The Effects of COVID-19 on Socioeconomically Disadvantaged Medical School Applicants

Perez, Michael; Williams, Cheyenne; Vapiwala, Neha MD

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doi: 10.1097/ACM.0000000000003613
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To the Editor:

The COVID-19 pandemic has upended nearly every aspect of undergraduate medical education, including the traditionally yearlong admissions cycle. For those who are first in their family to graduate college or apply to medical school and/or who hail from socioeconomically disadvantaged backgrounds, often referred to as first-generation and/or low-income students, this unsettling disruption to the admissions cycle may amplify already intimidating barriers to educational mobility.

With only 5% of medical students coming from the bottom 20% of U.S. family incomes, a significant disparity already exists in the representation of lower-socioeconomic status (SES) students in medical school.1 Aside from the obvious financial obstacles, these students’ on-paper achievements are potentially limited by opportunity costs, time constraints, and poor social capital. We are concerned that, with research projects suspended through the summer, limited clinical shadowing opportunities available, and the conversion of transcripts to pass/fail, there lies the potential for Medical College Admission Test scores, the prestige of undergraduate institutions, and/or the prominence of recommendation letter writers to fill the void in making admissions decisions. Furthermore, with university campuses closing and the consequent inability to pursue other paid opportunities, socioeconomically disadvantaged applicants may lack the financial capability to apply broadly to medical schools during this upcoming cycle.

In anticipation of these challenges, the Association of American Medical Colleges increased the upper limit of its Fee Assistance Program to 400% of the U.S. poverty level.2 To further the impact of this effort, lower-SES students may benefit from individual institutions waiving secondary fees and using virtual interviews. While these solutions may mitigate the financial impacts that lower-SES applicants face, they likely will not ameliorate the lost opportunities during this time. Therefore, we also propose that admissions committees acknowledge all applicants’ invitations to research conferences and summer programs even if they were financially or logistically unable to attend. Finally, the barriers overcome by lower-SES students, now more than ever, highlight their resilience and resourcefulness. Admissions committees can continue to increase equity for this group by valuing each applicant’s “distance traveled” when forming admissions criteria.

We believe the COVID-19 pandemic brought to the forefront issues that negatively affect socioeconomically disadvantaged applicants’ success in medical school admissions. Only a joint commitment across medical schools to maintain a holistic review of applications will shield these applicants from being further marginalized in upcoming admissions cycles and excluded from a workforce that desperately needs them.


1. Youngclaus J, Roskovensky L. An updated look at the economic diversity of US medical students. AAMC Analysis in Brief. October 2018;18:1–3.
2. Association of American Medical Colleges. Coronavirus (COVID-19) and the Fee Assistance Program. Published April 20, 2020. Accessed April 26, 2020.
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