Seeking Leverage in “Strong Ties”

Last Updated on March 1, 2023 by Laura Turner

What are “strong ties,” and what do they mean for health professional admissions? A “strong tie” is usually associated with the amount of time the applicant has spent within the community or state where the desired health professional program is located. Discussion of “strong ties” comes up frequently with applicants wanting to apply to out-of-state programs. In this article, we go through some general admissions policies to consider whether there is a preference during application review.

Types of “Strong Ties”

In-state Domicile and Geography

Most public institutions benefit from a budget line or an agreement from the state legislature that subsidizes enrollment of in-state applicants. Eligibility is often stated as a “domicile policy” posted on the public university website. Each policy lists evidence of domicile, such as an apartment lease, utility bills, bank statements, state identification, car registration, or tax forms as an independent filer. Voter registration is not always a factor, as many undergraduate students live outside of their home district but vote in races represented by precincts that include their campus. Based on your childhood residence or high school zip code, you could still be considered in-state as an applicant, though you may not be eligible for a tuition discount.

In-state and locality status also matters to private institutions. While there may be no set limit to the number of in-state applicants that can be enrolled, private schools want to train students who will ultimately work in the health systems affiliated with them, and local students benefit from familiarity with these hospitals when they shadow other professionals. Sometimes locality is extended to undergraduates who aspire to attend the professional programs run by the same university, but only if the candidates have been involved in pipeline programs with faculty, students, or alumni.

Military/Veteran Status

Because their families move frequently, military children who want to attend college often do not meet the requirements of domicile. Many states list exceptions for active military students, partners/spouses, dependents, and veterans. As a result, military/veteran applicants may find they are immediately eligible as in-state applicants for multiple states, even if their families move to a different state during the application cycle. Many universities have set up administrative offices to assist military/veteran students, especially to help apply for Post 9/11 GI Bill benefits.

Native Americans with Tribal Affiliation

Native American/Indigenous applicants enrolled with a federally-recognized tribe may also be considered in-state students. Many undergraduate programs have recently begun using these criteria to give tuition waivers to eligible applicants, so disclosing receiving one of these undergraduate waivers may also support your application. Admissions staff also recognize participation at regional or national SACNAS conferences to identify strong candidates for research tracks, including MD/Ph.D. programs.

MOU Guaranteed Admission Linkages

News outlets often spotlight high school seniors who “miraculously” have become “admitted to medical school.” This is possible because of BA/MD, BS/DO, BS/DDS, or similar guaranteed admissions programs that last six to eight years. The undergraduate (host) institution has entered into a memorandum of understanding (MOU) that establishes the criteria for allowing their undergraduate students to enroll in a graduate/professional program without going through the regular admissions process. Example criteria include, but are not limited to, a satisfactory science GPA, SAT/ACT scores, a clean student conduct record, exemplary letters of recommendation, and clinical experience hours. In return, many of these participants could be granted a waiver of admissions test scores (such as the MCAT) or a lower “passing” threshold. Guaranteed admissions students may also be interviewed to assure the admissions committee that these students have sufficient maturity and situational judgment skills to be admitted and become successful.

Often guaranteed track students will wonder if they could “do better”, so they consider dropping out of their track to become a regular applicant. Students should carefully consider the advantages of holding a guaranteed seat over the uncertainty of regular admissions. To this end, high school students who are genuinely dedicated to attending the professional program should apply for these tracks and take advantage of additional mentoring and support from current professional students and faculty/alumni during their undergraduate phase. The additional time acclimating to professional student culture will ease the transition.

Even if an applicant is not part of the guaranteed admissions track, one should still consider the health professions programs that have set up these agreements. These programs likely have a strong track record of knowing the undergraduate/feeder institutions, so they understand the level of preparation graduates from that school have to be successful students. That said, being at a feeder institution does not confer a “preferential” status to non-MOU students.

MOU linkages also exist for some special master’s programs. Completing an SMP with a specific GPA could make a student eligible for an interview at the linked professional program. 

Legacy Admissions

Legacy admissions have been heavily scrutinized, especially since the Supreme Court affirmative action cases against Harvard and UNC. Because alumni donors provide resources that can significantly improve the learning community, children of significant donors are thought to benefit from favorable admissions decisions, and admissions/enrollment professionals carefully navigate the ethical challenges that could arise. While few schools publicly state how they maintain this careful balance to assess legacy candidates fairly, all accredited medical schools must show they select students without any political or financial influence (LCME standard 10.2, 2023 version, accessed December 21, 2022*).

How the privilege of legacy is defined differently by each admissions committee. In some cases, the privilege is extended only if the candidate’s parents are graduates and long-time program donors (not any other school at the home university). Legacy status may be considered if the candidate is an extended relative of an alumnus (such as an aunt or uncle). Having a sibling who is a current student, resident, or alumnus could confer legacy privileges, though cousins are not eligible. While partners/spouses may be considered, step-family relations or in-law relations (including ex-partners) are not considered legacy candidates. 

(*) While the LCME standards explicitly ask that programs demonstrate their admissions process and decisions are made “without political or financial influence,” similar expectations do not appear in other accreditation standards governing other professional programs. 

Pipeline Admissions

The alumni of endorsed pipeline programs, such as the Summer Health Professions Education Program (SHPEP), are highly desirable among medical and dental programs. A 2015 study from Mathematica showed that SMDEP/SHPEP participants were 8% more likely to apply to medical/dental school and 10% more likely to get accepted and matriculate compared to non-participants (accessed Dec 21, 2022). Specifically, about two-thirds of all historical participants applied to medical school, and two-thirds of these applicants were accepted (February 2019 podcast transcript). No single component of the SHPEP program seems to influence acceptance; the combination of curricular and clinical activities and strong mentoring establishes a foundation for future application success. Similar pipeline-to-profession programs may also confer a similar signal to admissions committees regarding their preparation and mentoring as applicants and future professional students.

What May Not Be Considered a “Strong Tie”?

Over the years, many applicants list their discouragement with a rejection letter from a program where they thought they had strong ties. Here are some examples:

• Attending the undergraduate program where the medical, dental, or health professional program is also part of the university;
• Working closely as a collaborator to a university lab or organization, especially on research, fundraising, or community outreach;
• Born, treated, volunteered, or employed in a clinic or hospital affiliated with the medical, dental, or health professional program;
• Having relatives living in the state, unless the applicant has lived with those relatives for a significant time;
• “Significant partner” or in-laws living or who once lived in the state for a significant time, even though the applicant is not (yet) a resident.

Some programs may view you favorably if you have a sibling, relative, or a married partner who is a current student/resident in the program or at a similar professional track. Each admissions committee may treat such situations individually, and the success of the current student/resident could be factored into these decisions.

Leveraging “Strong Ties” in the Application Process

Having a “strong tie” with an area comes with the applicant showing they strongly identify and empathize with the community associated with that attachment. To illustrate that they identify with the people living in the area, the applicant should have community service experiences that show a close relationship with, and understanding of, the challenges that the community faces and needs that the applicant has experience discussing or addressing. Some applicants may have spent significant time through a frequent or recurring service project (like building houses for poor rural Appalachian families) that they can articulate in interviews and secondary essays. In this case, the applicant expresses – with evidence – their mission fit as a tie to the community served by the program.

Do “Strong Ties” Matter?

In the end, admissions committees want a mosaic of qualified students who share a strong purpose for their professional careers and fulfilling the program’s mission. Candidates with “strong ties” should be part of every class but are still part of a bigger picture that can represent diverse societal perspectives that health professionals should address with great empathy and professionalism. Applicants with “strong ties” should embrace their other colleagues with the same level of respect and humility as they learn and succeed together.

Investigate Before You Apply

Admissions offices should answer your concerns regarding these so-called “strong tie” preferences. Before you begin the application process, ask them how to describe your “strong tie” argument best and what successful strategies they have seen. They should also be able to connect you with current students or recent graduates who may have had similar challenges.