Improving Fairness for Medical School Admissions --Is a Lottery the Answer?

In 2020, as a response to Covid lockdowns, McMaster University used a partial lottery to determine who would be admitted to its medical program.

The Dutch have used a lottery system for decades (1972 to 2017, discontinued in 2018, will be reinstated in 2023) quite successfully and have a physician workforce that is as good or better than what the US has.

Lessons learned from 15 years of non-grades-based selection for medical school

Selection and lottery in medical school admissions: who gains and who loses?

Rationales for a Lottery Among the Qualified to Select Medical Trainees: Decades of Dutch Experience

Since there are many systemic barriers to diversity in medical school admission, the use of lottery has been suggested as a one method that could make med school admission more fair and could de-emphasize socio-economic factors that bias med school admissions today.

Accepting randomness in medical school admissions: The case for a lottery

At first, it may seem that leaving medical school admissions partly to chance could erode autonomy and meritocracy. Yet our current system for selecting medical students is strained by a limited predictive ability. In the search for good doctors, we lack meaningful, quantifiable, and comparable criteria. Partial or weighted admissions lotteries can offer us an escape. They have the potential to reduce mental and financial burdens on both applicants and medical schools, avoiding an overemphasis on marginal differences between applicants. Lotteries are also a simple way to address persistent admissions disparities by being truly non-discriminatory.

Lottery docs? Randomize medical school admissions for fairness

It’s this simple: The medical school admissions system is bloated and reinforces implicit and systemic biases leading to further social inequity.

Medical schools across the country are going through thousands of applications and making literal life-changing choices for these students. Introducing randomization into the admission process would simplify and address the built-in issues in this process.

Admissions tests do not determine the quality of a doctor’s care.


Thanks for the thread, link and info. Very interesting reading! Can’t wait to dig in more.

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What is interesting is not the use of lottery, but the fact that they are ALSO using holistic admissions criteria.

The first line of the first article cited in the OP starts:

"Thirty years ago, it was suggested in the Edinburgh Declaration that medical school applicants should be selected not only on academic, but also on non-academic, attributes. "

People on CC have repeated used the UK system and other European systems, which are not “holistic” as more “fair” systems. It is interesting that, at least for selection of students for medical school, holistic admissions has been pushed in Europe as being more fair and equitable.

Anyways, regarding the lottery. It is true that, over a wide swathe of GPAs, training, and test scores, there is no difference in the ultimate success as Physicians. So a person with a GPA of 4.0 is not going to be a better surgeon than a person with a 3.95 or 3.90. Therefore it really does not make sense to select a person for medical school based on where they are within that range.

We have repeatedly said here on CC that there are far more highly qualified applicants than can be admitted to popular colleges and medical schools. If that is so, a lottery between all of the highly qualified applicants makes as much sense as choosing a person with a GPA of 3.99 over a person with a GPA of 3.96.


My biggest concern with selecting med school students after ability to handle it academically is how good they are interacting with people. That’s an important part of the job. There’s no exact science to getting it right, but a pure lottery won’t do it. A bar to pass to get into the lottery would help.

Currently that’s a lot of the non-medical ECs on an App, etc.

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The problem with the ever increasing arms race in ECs is that it is unfairly burdensome on applicants from lower SES and non-traditional backgrounds.

I highly recommend reading Mazer’s article.


My opinion…there are some academically excellent but not superior students who have excellent people skills, and would excel as doctors. I worry that without an interview, medical schools will be filled with books smart people without terrific people skills.

The times I have sought a different doctor was because the interactive communication skills were lacking…not the academic skills. No…I don’t expect my doctors to be my best buddies, but I do expect them to speak to me with caring and compassion in real people language.

I think this lottery thing could save medical schools a lot of time…but I worry that this plan would also leave out folks who would be excellent physicians.

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I have come across many terrible doctors that have zero people skills. I don’t know if a lottery would improve things, but some changes should be made to ensure doctors also have better soft skills.

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It seems to me that medical schools are trying to create a patch for a problem that they themselves have created.

It used to be that students finished four years of college and then directly applied to medical school. Now it’s expected that they spend a year or two “demonstrating interest” by spending time working in a health care setting at low pay. This effectively results in one or two years less of earnings, thereby making medicine less viable for lower income students.


There is currently a 13 year old girl in the news for already having been admitted to a medical school early assurance program . Seems premature to me at that age but what do I know.

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@thumper1 The current plan already leaves out lots of folks who would be excellent physicians. More than 65% of applicants don’t get any acceptances. I’m sure they’re not all terrible candidates with zero people skills.

(In fact, if the results of the Dutch lottery experience are to be believed, by the end of medical school, there are little to no differences between traditionally admitted students and lottery admitted ones in persistence, OSCE scores, professionalism, academics, dedication to the profession etc.)

Also,the lottery doesn’t necessarily do away with the interview. McMaster’s lottery only included those students who had already been interviewed and found to be acceptable.

That works

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The news item was misleading. She wasn’t accepted to medical school. She was accepted to a early assurance program which means when she graduates from college–2 or more years in the future – she will be admitted to the medical school if she has met the conditions set by her program. (attaining a particular GPA, maintaining her ECs and clinical experience, passing an interview)

Basically it was a chance for U Alabama to grab some headlines and guarantee the enrollment of a talented URM student who if she continued on a traditional pre-med path would have certainly garnered multiple acceptances to more prestigious medical schools.

In the past several med schools who have accepted exceptionally young students into med school have “strongly insisted” they take a detour during their pre-clinical years (often to do research/earn a PhD) so that they are closer in age to more traditionally aged med student by the time they start their clinical rotations. Seriously can you imagine a 16 year old taking a detailed sexual history from an older individual? Can you imagine being the patient in that situation?

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I don’t know - I think it depends on the specialty. Pediatrician- definitely. But there are some doctors I’ve experienced who are downright terrible with interaction - either strange or seem almost mean. But they’re really good at their specialty and I wouldn’t trade them.


I edited within a few minutes of my initial post to say it was an early assurance program. You may have missed my update.

I’m quite ok trading them. Too bad there isn’t a people skill grade we can use when selecting someone. I have little use for people who are mean.

There are enough students academically able to handle med school that we don’t need those who aren’t also good with people.

That said, I’d be content with a lottery post minimum bar met (whatever that is for the school) and interview.


My GYN has exceptional people skills- top 5% type. Empathy, listening, the bells and whistles. He referred me to the top Gyn-oncologist in my area with a warning- “She won’t be your friend, but I would take anything she tells you to the bank”.

That’s ok with me. Not everyone needs to have everything. I had a scary medical emergency a few years back- the attending in the ER was compassionate and kind and all sorts of emoting and loving. The surgeon who did the procedure (it was an emergency so no time to shop around or get a second opinion) was something of a robot. Post-op, every medical person I saw for follow up got a teary look in their eye when they read on the chart that he had done the procedure-- basically said some version of “I’ve seen him do procedures nobody else would try, and the patients walk out of the hospital and resume their lives. You are so lucky he was on call that night!”

I’m good with that. Really don’t care about his soft skills. Surgery takes a lot of focus, skill, stamina, dexterity- and if he’s not Mr. Congeniality as well I think society is still better off.


To each our own. I’m content with that.

But with oodles of people being denied entry into med school, I see no reason why there aren’t enough capable people with soft skills as well as medical skills.

I know I’m biased. I saw my mom practically killed by a jerk who didn’t care and couldn’t even say he was sorry once he had been proven wrong. She did eventually die. Had it been caught earlier when she started telling him what was wrong, who knows? IMO he’s the worst of both, soft skills and medical skills, but soft skills sure would have been helpful.

He’s not a recent med school grad either. He may have retired by now.

Otherwise anecdotally, I see tons of people who won’t go to a doctor (pretty much any doctor) due to having been turned off by lack of soft skills from prior experiences. I’m one of them, so it may be part of “birds of a feather,” I’m not sure. Regardless I don’t see where that helps anyone medically.


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Yes, we probably should train 18 year olds to preform specific surgical procedures rather than sending them to college, post college prep years, and medical school first. Why not use the years when their coordination, reaction time, eyesight etc. is the sharpest? MD’s who have been through residency could make the medical decisions, but those doing the cutting etc. can just be experts in that procedure.

If gaining access to a profession becomes a lottery a lot of high skill/talent kids probably will not enter the path. This is just human nature. Whether that becomes a problem for society later on is a separate issue. You will never know who you’ve missed.

The pay in the medical profession in the UK is poor. What are the odds that the quality of doctors in the uk is the same as the quality of doctors in the us? Very low. Likewise all these changes will have a long term impact that are hard to see upfront.

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