The Consequences of Poorly Conceived Admission Requirements

From “The relationship between required physician letters of recommendation and decreasing diversity in osteopathic medical school admissions“:

Osteopathic and allopathic physicians, DOs and MDs, are already essentially the same and have been increasingly so over recent years. But one admissions practice is very common for osteopathic schools and exceedingly rare for allopathic schools: requiring a letter of recommendation from a practicing physician (PLOR):

Although requiring a PLOR is very common practice among osteopathic medical schools, with 81.8% (36 out of 44) requiring it, it is rare among allopathic schools, with 3.9% (6 out of 154) requiring a PLOR. Allopathic medical schools only require LORs from a student’s undergraduate institution and strongly recommend a clinical letter but do not require it. According to the Association of American Medical Colleges (AAMC), allopathic schools matriculated 14.6% URM students in the year 2020 [28], compared to 11.1% URM students at osteopathic schools [4]. They also had more than double the percentage of Black matriculants (7.6 vs. 3.3%) [4, 28].


On average, schools that required a PLOR have 37.3% (185 vs. 295; p<0.0001) fewer Black applicants and 51.2% (4 vs. 8.2; p<0.0001) fewer Black matriculants.

That’s a painful number. Schools that have this requirement receive end up with half as many black students.

Perhaps there are confounding factors here, but that difference demands at least further study. Frankly, I’m not sure whatever the purported benefits of a physician letter are that they could possibly justify the practice given the functional barrier they seem to create.

If you look at the data, applicants across the board are actually down with the requirement. While the barrier wasn’t specific to any group or underrepresented minority, the changes reached statistical significance only in that subgroup. It’s just a cudgel to decrease the admissions administrative burden.

I’ve written before about the “good reason to be a doctor” police. I think we, as a profession, are simply not that good at choosing candidates, and I sincerely doubt a letter from a random doctor means literally anything. Letters of Recommendation are mostly useless, but I especially fail to see how a letter from someone you follow around for a shadowing experience tells me anything about you as a person that I care about that couldn’t be determined from someone else.

There are social determinants of medical school admissions that are entrenched and difficult to change. Then there are the incredible costs of medical school that are baked into the status quo. But this? This is not a good or equitable way to shrink the applicant pool to a more manageable size for the admissions committee.

This is a petty, minor detail that every school should delete today.

(hat tip Bryan Carmody)

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