From Waitlist to Offer: Inside an Admissions Committee

Last Updated on February 14, 2024 by Laura Turner

You are finally done with your interviews, so let the waiting games begin! In March, health professions programs will begin securing seats for the next incoming class, and waitlisted candidates hope for a welcoming phone call with an offer. In this article, I discuss the processes of the hypothetical Interprofessional Health Opportunities Program (IHOP) introduced in a previous article. These mirror the systems used to manage alternate lists at many health professions programs (or higher education programs in general).

Note: Individual programs keep this process confidential. Any resemblance of this hypothetical scenario to any specific program’s screening or deliberative process is coincidental.

The Post-Interview File Review

Regardless of the interview format, applicant files are holistically evaluated for a post-interview decision, usually within two weeks. Each applicant file met or exceeded a threshold screening score to earn an invitation to interview. GPA guidelines help us separate “high metrics” applicants from others (endearingly called the “bent arrows” or “rough diamonds”). Still, biomedical science coursework (especially the last 30 credit/semester hours within the last two years) helps us separate candidates we want from those we relegate to the waitlist. The IHOP screeners triage applicants into similar academic comparison groups: those with just undergraduate coursework, those with postbaccalaureate courses, and those from special masters programs; each group is evaluated on similarly rigorous upper-level science coursework. We rely on academic letters of recommendation to see what the professors say about how the applicant thrived using their teaching strategies, especially if they used case-based discussions, research, or experiential learning. Professors who only know their students from their lecture hall seats don’t impress us; we want to know what the professors (or prehealth advisors/committees) care about and how they express an investment in the student’s success. Our rubric is flexible and reflects our insights into the applicant’s academic successes in research theses or capstone reports communicating difficult concepts (especially data analysis), applying concepts as evidence of scientific competency, and adapting to challenging teaching and learning styles without resorting to shortcuts (cheating, plagiarism, or overreliance on generative AI tools).

The next thing our screeners help us score is “mission fit” factors. We expect all applicants to have fully understood our program’s mission and vision, but those statements represent our ideal impact for the entire class. Our students don’t just learn from sitting in lectures; they become part of our mission through the shared stories and lived experiences of peers, preceptors, and alumni. We want you and our community members to be inspired to excellence in academics, research, and community impact. We want to see your reflections on experiences that show us you aspire to meet our standard of excellence, especially with the opportunities and resources we provide you. Our job is to select a diverse class that shows signs of excellence in different talents or perspectives that enlighten us about what the future holds for our healthcare providers. We carefully read your essays or watch your recorded video interview responses for a roadmap that underscores areas of excellence and potential excellence that will help our program achieve its mission.

One of the most important questions we must ask ourselves is how motivated you are as a lifelong learner. The significant events that shape your worldview and work ethic inform us about how likely you are to seek help and lean on mentoring to succeed each day. What support mechanisms do you rely on to excel, and can our program supplement them when times get more challenging? Are you eager to learn about new ways to do things (including studying or scheduling time) rather than rely on old methods that are comfortable but less effective?

After we interviewed you, many of us became interested in your situational judgment test results. Some schools with more experience use SJT results for screening (before an interview) to validate their assessment of essays or evaluations. In contrast, others use them to predict your performance in their interviews (or instead of running their own multiple-mini interviews due to their lack of resources). Our team balances them with your interview scores to place value on your decision-making processes that complement the mission-oriented questions we may have asked you. (This insight is derived from the 2023 HPSA/SDN Situational Judgment Test Experience Survey results.)

At IHOP, mission fit scores (which include knowledge of the program, impactful experiences/work/activities, secondary essays, and demographics) are calculated independently from the screening scores (GPA, exams, hours of relevant activities). To get an interview, the screening score must place the candidate within the upper 20%, with a mission fit score within the upper 40%. We put applicants on an “interview hold” if their screening score is in the top 50% and mission fit in the top 50% but below the earlier mentioned threshholds. (We deny applicants without an interview if their scores are in the lower quartile of both screening and mission fit scores.) To get an offer, candidates must be in the top 15% of the mission fit score that now includes the interview performance; the academic screening score is not additionally considered for offers, but could be a factor for waitlist ranking.

The Staircase Analogy: Sorting Interviewees

Frequent premedical forum posters are familiar with the “Staircase Analogy” when they ask why schools have not communicated a decision after an interview. Longtime revered expert and admissions faculty member “LizzyM” explains that applicants are grouped after screening and scored by priority to receive an interview invitation:

I have a staircase analogy. Imagine a broad staircase. You are positioned on this staircase with other applicants on the same stair and with others higher and lower than you and your cohort. As more applicants are interviewed, the new folks will be assigned positions on the staircase. You can think of this as the waitlist. Eventually, starting at the top of the staircase, applicants will be issued offers of admission. Whether you will be high enough to get one depends on how the people coming after you for interviews perform. If they do less well, you may be toward the top and get in, but at this point, schools are biding their time and waiting to see how the cycle plays out for them.

LizzyM – Link to post

At IHOP, getting to the top step of this staircase does not depend on your GPA, test scores, and interview results since everyone met the same academic screening cutoff of being in the top 20%. Unless there is a demonstrable mismatch, all interviewed candidates are placed on an offer waiting list by their mission-fit score. Sometimes, the admissions committee will send post-interview rejections to applicants with the lowest mission fit scores (bottom 5-10% at first) to keep the waitlist at a certain number. We tell the applicants in the bottom half of our waitlist that they should begin planning a new application or consider other options. In contrast, those in the upper half can get a phone call from us right up until orientation.

This explains the frustration of many high-metric applicants when they see their applications receive waitlist decisions as others with lower metrics get offers. Schools often adhere to schedules when extending a fraction of the available seats while interviews are ongoing. All health professions programs are expected to have extended enough offers to fill their seats by March before the start of the new academic year, even if additional interviews are scheduled in April and May.

Creating The Waiting List

IHOP interviews 1000 applicants (from a 6000-person pool) to fill 100 seats for their upcoming class. Assuming that every applicant is qualified and no post-interview rejections are issued, they strictly extend offers to 10% of their interviewed candidates (from the previous month) on a schedule so that the class fills when they have completed interviews in March. Additional interviewed candidates may be taken from an interview “hold/waitlist” pool as interview spots open. All relegated candidates are considered for any available spots in the class in the spring under this hypothetical.

Month	Interviews	Offers	Waitlisted
(By) September	300	0	0
October	250	30	270
November	200	25	495
December	50	20	675
January	100	15	710
February	100	10	800
March	0	Take from waitlist as needed to fill 100 seats; check multiple-deposit notices	900 max, to be priority-ranked for an offer
Total	1000	100 (number committed may be smaller due to post-interview declines)	900 (the real number is smaller due to post-interview withdrawals); the desired size is 750 by May 1.

Signals and Updates: Do They Matter?

With these possible waitlist management factors in mind, can a candidate influence their placement on an alternate list? Frankly, it is very difficult to know. 

In our process, updates are welcome on your interview day. Many faculty interviewers will welcome any updates or clarifications if they conduct open-file interviews with you. You can also send in short updates to be placed in your file before your interview day or immediately afterward; you should ask the admissions team when they are most receptive to these updates. Once the interviewers submit their impressions, their scores and feedback are locked in for the admissions committee. Your fate is “sealed,” so post-interview updates don’t sway us.

In our process, your score is fixed as an alternate. We found that adjusting dozens of applicants’ scores did not help the candidates, and most of those who sent us updates did not enroll in our program after they were accepted off the waitlist. Additionally, many faculty believe “signaling” could inappropriately introduce a cultural bias as it may be considered culturally offensive to applicants or some faculty members. But other admissions committees welcome additional information gained from an additional semester of coursework, significant awards or recognition (like getting a Rhodes scholarship or being admitted to the Peace Corps), or significant timeline changes (like graduating early or beginning a job on a full-time basis).

The most impactful updates reconfirm the candidate’s alignment with the program, especially when summarizing mission fit and core values, and they usually reaffirm our mission fit evaluation. These updates or “letters of interest” succinctly remind admissions committee members of their deep knowledge of their program and their enthusiasm to fit in. Updates should be scheduled as instructed by the admissions office, but one significant update is preferred over multiple incremental updates.

Admissions offices frequently query alternates to ensure they still want to be considered for an offer. This helps to refine the alternate pool and eliminate any applicants who may have received offers at schools that are a better fit for them. Sometimes, the applicant-initiated withdrawals prevent the admissions office from sending out “rejection waves,” so we appreciate honest responses. If you don’t want to come to IHOP, don’t stay on our waitlist.

In contrast, for residency applications, signaling might help program directors sort through applications to find candidates worth interviewing. As residency programs fine-tune their signaling protocols, medical student deans will receive more insights.

Post-Script: “Consider Other Programs at our School/University.”

Many waitlisted applicants on the lower steps of the staircase will receive emails to consider enrolling in other programs their school or university offers. Don’t get upset; our admissions office must focus on filling all our seats at IHOP, not just your preferred program. Some candidates, likely in the lower half of the alternate list, could be encouraged to apply to their program’s postbac/special masters program, a pre-PhD/research postbac track, or other health professions programs (such as dental, pharmacy, podiatry, optometry, or public health). If your end goal is to be an effective healthcare provider for your community, do a personal reflection about the appeal of the program at that school or university; all health professions need passionate, diverse, empathetic professionals and caregivers, and these alternatives may be better suited for your purpose (and your bank account) in impacting community health. Considering the additional financial and emotional cost a reapplication cycle may bring, you should consider the benefits of taking advantage and moving forward.

However, abandon any thought that you could transfer from one program to your desired program without an articulation agreement. IHOP physician assistant students cannot jump to the MD/DO program after one year of good academic performance (or vice versa if a medical student performs poorly). Our special master’s program does allow students who fail to qualify for the medical school guaranteed interview to be considered for our other programs (like physician assistant, pharmacy, optometry), so keep your options open if you experience academic problems while in our postbac program. Whatever we do, we will continue to support you in your pursuit of a healthcare career that addresses the health needs of our communities in a role that fits your talents and motivations.