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The 'Trojan Horse' of Medical School Admissions

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Several images may come to mind when one hears “admissions advisor” — a crowded office, college pennants scattered on the wall; someone scrutinizing your curriculum vitae behind a tidy desk; or that one doctor-cousin who your mom always compares you to. After the “Varsity Blues” scandal in 2019, a negative connotation arose: someone who can offer a backdoor to coveted positions in higher education … for a fee. While this represents the extreme of how college/graduate school advising services can manifest, it reflects the notion that one can pay for an advantage in a process that is meant to be equitable.

While there has been much effort over the recent decades to promote equal accessibility of the medical field to all individuals, there has been no consideration of advising services and the role they might play in giving certain applicants an advantage in gaining admission to medical school. In this article, I hope to introduce the potential influence they might have in detracting from equitable medical school admissions and do so from my own perspective as a former medical school advisor.

The emergence of medical school advising services becomes clear when observing applicant trends. From the 2020–2021 application cycle, 40% of 53,370 applicants received an acceptance to an MD program. The number of applications rose to 62,443 for the 2021–2022 application cycle, with the acceptance rate dropping to 36%. I started performing medical school advising services during those years because I saw an opportunity and demand to use my knowledge of the application process to help others get accepted to medical school. For me, the monetary benefits paled in comparison to the idea that, with my guidance, I could make a significant positive impact on the path of an aspiring physician.

I began by studying mine and others’ application experiences to understand what themes and strategies were effective. I advertised a strategic approach that came from two angles. The first involved the primary elements of the application: developing narrative personal statements, optimizing extracurricular descriptions, tailoring secondary essays, and interview practice. The second involved the often-neglected elements: an optimal school list, prompt submission of essays, timing of update/intent letters, and sending “thank you” messages to interviewers. One of my clients, a classics major, joked that medical school admissions was now like a “wall of Troy,” where the tenacity, dedication, and resilience that once were the recipe for acceptance were now insufficient without cunning; and that I was his “Trojan Horse.” As I continued to operate my service, I began to understand how accurate that analogy was; and ultimately, I realized that my “cunning” was contradictory to my fundamental belief that medical school admissions should be fair.

What eventually became clear to me was the connection between advising and deep-seated issues of privilege that influence admissions into higher education. The beneficiaries of advising services were not the ones who needed it the most — they were often those who needed it the least. A Google search of advising services will yield costs ranging from $20 to $200 per hour, with some services offering “packages” for thousands of dollars. (One service advertises a “Diamond Package” guaranteeing acceptance to medical school for $11,000.) Therefore, students who seek the services of an advisor are not those in debt to afford their college tuition, or the underprivileged first-generation aspiring doctor — they are most likely the wealthy, privileged students who can afford these services.

The idea that privilege influences academic success is not new, and diversity initiatives have accompanied a departure from strictly objective metrics (e.g., GPA, MCAT). We now have a more holistic appraisal that considers an applicant’s socioeconomic status, family circumstances, race/ethnicity, and unique experiences — their narrative. The problem with medical school advising is that it takes advantage of the narrative elements: the personal statement, secondary essays, and experience descriptions. When a medical school application arrives on the desk of an admissions committee member, there is no way to discern whether the writing was individually produced by the applicant or had the contribution of a paid advisor. Like the soldiers hiding inside the Trojan horse, the benefits from medical school advising are disguised as what is claimed to be one’s own application, and these written elements can mean the difference between an interview invitation or rejection. Thus, an applicant who used an advisor will be able to present a more palatable and compelling narrative, whereas an applicant who could not afford advising has to rely on their own ability and navigation of the admissions process.

The reality of medical school advising is that although it may seem like subversion, that is not the case. The AAMC does not list any regulations regarding the use of a medical school advisor. Thus, medical school advising will likely remain increasingly influential in the admissions landscape. Rather than condemning advising, we need to further explore how it influences admissions. I recommend three initial actions by AAMC: Bolster awareness of medical school advising as a factor in admissions, gauge the prevalence of advising use by surveying incoming medical students, and support access to free/low-cost advising services for underprivileged/underrepresented applicants.

I discuss medical school advising neither to condemn it nor to devalue the efforts of those who used it, but rather to garner awareness that it may be playing an increasing role in medical school admissions. As admissions become increasingly competitive, committees will only further increase their focus on the narrative of the applicant. This leaves greater room for influence from those who know how to craft these elements; and ultimately, it will be the wealthier applicants that will be more poised to take advantage of this through an advisor. Admissions committees thus need to view medical school advising as a factor in equitable admissions and take measures to further understand its influence on who is gaining admission to medical school.

What are your thoughts on admissions advising? Share in the comments.

Rajiv S. Vasudevan, MD, is a resident physician with the Yale School of Medicine Department of Orthopedics and Rehabilitation. Follow him on Twitter ‘X’ @VasudevanRajiv.

Image by GoodStudio / Shutterstock

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