Deferred rejection: longer college admission wait lists

College waiting lists are a bit of a misnomer--they aren't ordered lists, they are more like waiting pools from which candidates can be drawn if the yield from regular admissions falls short.

The WSJ has the story:
College Wait Lists Are Ballooning as Schools Struggle to Predict Enrollment
The chance of getting off the wait list has plummeted at many schools as the pool has expanded

"As hundreds of thousands of high-school seniors face a May 1 deadline to put down deposits at their college of choice, many still face uncertainty over where they will end up. Their futures are clouded by the schools’ use of wait lists to make sure they have the right number, and type, of students come fall.

"The University of Virginia increased the number of applicants invited onto wait lists by 68% between 2015 and 2017. At Lehigh University, that figure rose by 54%. And at Ohio State University, it more than tripled.
...
"[Carnegie Mellon University], with a target of 1,550 freshmen, offered wait-list spots to just over 5,000 applicants this year.

"“You can take stock and ‘fix’ or refine the class by gender, income, geography, major or other variables,” said Jon Reider, director of college counseling at San Francisco University High School. “A large waiting list gives you greater flexibility in filling these gaps.”

"This year, applications to Carnegie Mellon rose 19%. With more students accepting its offers of admission, it couldn’t risk over-enrolling. The school admitted 500 fewer students and expects to go to some of its wait lists to make sure each undergraduate program meets enrollment goals, and that there is a good mix of students, including enough aspiring English majors or kids from South Dakota. The school can also take into account the financial situations of wait-listed candidates."

The politics (and incentives) of liver transplants

From the LA Times: California has long wait lists for liver transplants, but not for the reasons you think

"About 7,000 people get a liver transplant each year in the United States, while 17,000 remain on waiting lists at transplant centers. Who should get a lifesaving transplant has always been a complex calculation. But it has blown up into a vicious political struggle that played out most recently at a meeting of the organization governing the nation’s transplant network.

"The benefits of liver transplants are astounding. Patients just weeks from death can have their lives extended significantly, even indefinitely. Given the limited number of donor livers, in 2000 Congress established what’s called “the Final Rule” to guide the medical community in how to allocate them fairly. The Final Rule compels the transplant community to allocate donor organs based on best medical judgment, best use of the organs and avoidance of futile transplants. It also notes that a patient’s chance of getting a transplant should not be affected by where he or she lives.

"Balancing these various guidelines has always been tricky. But what has emerged — and is now the point of contention — is a marked geographic disparity in how sick a patient must be before rising to the top of a transplant list. For example, waiting lists at California transplant centers are significantly longer (and therefore patients in California get a lot sicker before possibly receiving transplants) compared with waiting lists in Oregon. That’s unfair to the Californians who need liver transplants, right?

"Acting on this assumption, the national board of the Organ Procurement and Transplantation Network / United Network for Organ Sharing, or OPTN/UNOS, proposed new boundaries for the nation’s transplant regions. The aim was to have regions with shorter, less-sick waiting lists share the limited supply of donor livers with regions that have longer, more-sick waiting lists. The new map was recently offered for public comment and a regional advisory vote.

"Eight of the 11 regions came out against it — because longer waitlists aren’t necessarily a sign of greater need.

The divide is deep. Antagonists have split into camps (“Liver Alliance” versus “Coalition for Organ Distribution Equity”), hired lobbyists and collected their congressional representatives. Given the uproar, it was not surprising that the OPTN/UNOS board of directors declined to vote on the controversial proposal at its national meeting in St. Louis last week. Nevertheleess, there’s a feeling of urgency that something must be done, so it’s entirely possible the board will soon enact the redistribution proposal — perhaps with minor modifications — despite present objections.
...
"Transplant waiting lists also get distorted by intense competition in populous regions where there are more liver transplant centers — a largely ignored issue. With money and prestige at stake, centers are motivated to perform more liver transplants. The simplest way to accomplish that is to put very ill patients on the transplant list, because when a donor organ becomes available, the center with the sickest listed patient in that region gets the organ.

Unfortunately, this encourages centers to list sicker patients over those who have the best chance of long, high-quality lives post-transplant.
...
"Rates of organ donation, by the way, do not explain the wait-list problem: California has some of the highest donation rates in the country, while New York persistently ranks at the bottom. Everyone agrees on the need to increase donations — but just redistributing livers will not significantly change the number of transplants or lives saved.

"Still, the disparity between the wait lists causes endless teeth-grinding in the transplant community.

"There is no question that wait lists are abhorrently long in some places, but OPTN/UNOS’ redistribution proposal misses the larger point: What is it about our transplant system that has created this situation? How can we make changes to keep the wait lists at more reasonable levels?

"Matters of healthcare access, while important, are beyond the control of OPTN/UNOS and the transplant community. Within grasp, however, is a simple solution: Lower the number of patients on transplant lists. Such a move would not affect the number of transplants (every available liver would still be transplanted), but it would reduce the delay and degree of illness for those on the wait lists. This is, of course, simple to say, but difficult to implement given how our current system incentivizes transplant centers to get as many patients on their lists as possible.

"To create a fairer balance between the haves and have-nots, though, both factions in the liver debate need to understand (and agree on) who the haves and have-nots actually are. Without consensus on that, we risk missing the big picture: increasing the health, happiness and well-being of more people with liver disease."

Dr. Willscott E. Naugler is an associate professor and medical director of liver transplantation at Oregon Health & Science University in Portland. He also serves as the Region 6 (Pacific Northwest) regional representative to the UNOS Liver and Intestine Committee."

Gaming the waiting list for a heart transplant

The heart transplant waiting list is game-able, since your place on the list depends on what treatment you are getting. So your doctor can "treat your priority" as well as treat your medical condition.  Here's the story from NPR:
Should Doctors Game The Transplant Wait List To Help Their Patients?
 July 24, MATTHEW MOVSESIAN

And here's an old (2013) editorial on the subject in The Journal of Heart and Lung Transplantation:
The urgent priority for transplantation is to trim the waiting list by Lynne Warner Stevenson:

"Current definitions of priority levels have been based both on medical rationale and the attempt to protect the system from being “gamed.” When the requirements for inotropic therapy for Status IB and pulmonary artery catheters for Status IA were adopted in the USA, it was with optimism that they would be used only when absolutely necessary to prevent imminent death, because continuous inotropic infusions and indwelling pulmonary artery catheters are inconvenient and costly and have been associated with serious complications. Although individual cases trigger heated controversy in regional committees, it is generally agreed that these therapies are being overused in patients awaiting transplantation.

If high priorities defined by therapies are the only route to access donor hearts, we face conflicted incentives as advocates for our patients. This is serious enough with incentives to inflate the description of severity of illness, but even more serious with incentive to impose interventions with complications, such as indwelling pulmonary artery catheters. One of the major conditions currently cited as justification for Status IA exceptions is vascular complications of indwelling catheters that preclude further catheterization. This complication on the list was virtually never seen before pulmonary artery catheters became an index of priority (although arrhythmia device leads have also added to the vascular complication rate).

The strength of inverse incentives in care of our waiting patients is indexed to the concern that they will die before a transplant, or will develop unnecessary risk such as from cachexia before they finally enter into transplant. The priority status will more truly reflect patient illness when the listing physicians have reasonable confidence that patients will receive a heart in a timely manner, a confidence eroded by the lengthening waiting times, which in turn reflect the anasarca of the waiting list."

HT: Marc Melcher

Organjet versus regional transplant lists

Forbes discusses the unequal waiting times for deceased donor organs caused by the fact that transplant waiting lists are organized regionally.

Your New Liver Is Only A Learjet Away: First Of Three Parts

"Tayur’s initial business model for OrganJet was quite simple. OrganJet would charge a modest fee to help clients figure out which transplant programs would be likely to shorten their waiting time for an organ. Clients could then sign up to have access to an on-demand flight, in case one of those transplant programs called up with an available donor. Having a flight at ready disposal is critical because many transplant programs require patients to arrive within six hours after an organ becomes available, or they pass the organ on to the next person on the list. The six hour requirement exists because in organ transplantation, donor organs need to be placed into recipients in a timely manner or the organs accumulate irreversible damage. Thus, if a patient on the transplant waiting list in, say, Pittsburgh cannot make it there in time, the transplant team will call another candidate until it finds one that can make use of the organ.

Excited about his chance to address an important social problem, Tayur began working through the details of his business plan, issues such as how many jet companies he would need to contract with and how much money he would need to charge customers for a given flight. “I envisioned OrganJet as an opportunity to make some money and save some lives at the same time,” Tayur told me, words not that different from what honest medical school applicants would tell interviewers about their career choice. The fees he charged customers for these flights would not only cover the charge of paying for the pilots and the fuel, but would include a surcharge that would be the source of OrganJet’s profits.

Tayur was excited about his idea, but the more people he bounced his business plan off, the more pushback he received. In particular, many people told Tayur his idea would only promote greater unfairness in the transplant system, by further disadvantaging people who lacked the financial resources to pay for OrganJet’s services. Tayur thought he could minimize this problem by convincing health insurance companies to pay for the flights, but his critics pointed out that many low-income patients wouldn’t be able to afford such generous insurance.

Tayur realized his new company needed to become two new companies. He had already incorporated OrganJet as a nonprofit entity in May 2011. So in July of 2012 he started a second company, GuardianWings, a tax-exempt nonprofit that raises funds to cover flight costs for low-income patients. His vision was now clear – he would work to overcome geographic inequities in transplantation one patient at a time, giving everyone a fair shake at life-saving treatments even if they were not wealthy CEOs."
...
"Neither Medicare nor Medicaid currently pays for OrganJet’s services, and it is too early to tell whether private insurers will embrace OrganJet’s prices. Tayur, the CEO of OrganJet, is still negotiating with insurance companies on a case-by-case basis. He is also negotiating with large companies that self-insure their employees, presenting them with results of statistical analyses he has conducted which demonstrate that OrganJet’s services could save them money: “It would get their employees off dialysis sooner, not only improving their quality of life in the process, but also allowing them to return to work sooner, with greater productivity.”"

Deceased donor waiting times, and OrganJet

Here's an article by Daniela Lamas in the Atlantic on waiting times by region, and how to register at a transplant center outside of your home region:

A Private Jet Is Waiting to Take You to Your Kidney Transplant
"Waiting lists for donations can vary dramatically between cities--so OrganJet provides planes to fly patients to their new organs."

The article focuses on Sridhar Tayur, and OrganJet: my previous posts on OrganJet are here.

Patients can register at multiple transplant centers to get on multiple (regional) organ waiting lists

You don't have to be Steve Jobs to get a transplant in Memphis.
Here's an interview on multiple-listing yourself.

Multiple Listing to Reduce Wait Times for Transplant Patients
Mediaplanet sat down with Dr. Sridhar Tayur, owner of OrganJet, to learn how to list smartly.

MP: How does geographical location affect an organ transplant?
ST: The wait times are strongly correlated to geography. In New York, New Jersey, Boston, Atlanta, Chicago and Los Angeles, the wait times for kidney and liver transplants are very high compared to those at centers elsewhere. Patients in the high wait areas can list in a center with low wait in other geographies, depending on their insurance coverage and ability to travel or move.
...
MP: How can one find a low wait transplant center near their home?

ST: The data is available publicly through Scientific Registry of Transplant Recipients' website and is updated periodically.

MP: What can early transplantation mean for patients?

ST: In the case of kidney transplantation, you could get a transplant before you even go on dialysis. If you are already on dialysis, earlier transplantation has two benefits: better outcomes and less time on dialysis. It is also important to know, for kidney patients who have been on dialysis for a while or have been listed in one center for a while, they can transfer this wait time so far to a different center and so take credit for "time served." For a liver patient, getting a transplant at a lower Model for End Stage Liver Disease (MELD) score also means better outcomes and less inconvenience during pre-transplant time. In all cases, the outcomes are better and life before and after transplant is better. Listing in more than one place is allowed and patients should look into the many benefits of multiple listing. 

Private and public healthcare in Israel

In Israel, there is disagreement over the right ways to mix publicly funded health care and private insurance. Here's the story from Haaretz:
In dramatic decision, private medical care banned in Israel's public hospitals
Although committee headed by Health Minister Yael German banned private services, medical tourism is still allowed, though it is unclear to what extent.
By Roni Linder-Ganz | 16:39 25.06.14 |

"Private medical services, popularly known by the Hebrew acronym sharap, would no longer be permitted at government hospitals if the recommendations of a committee headed by Health Minister Yael German are adopted."

Here's an ungated report: Health Minister: No Private Care in Public Hospitals  

Health Minister (Yesh Atid) Yael German announced on Wednesday, 27 Sivan 5774 that after about a year of deliberation and meetings, the committee she headed has decided private “Sharap” (שר”פ – שרות רפואה פרטי) medical care would not be offered in the nation’s public hospitals.

German is a supporter of the Sharap service and during the months of meetings she tried to persuade her colleagues to vote in favor of the option, a move she feel would improve the nation’s healthcare as well as shorten waiting lines for appointments with experts.

However the committee decided against it for it believes it is better for the masses to place more of the health care burden on the government instead of the private citizen.

Globes reports that “supporters of private medicine included German herself; Penina Koren, the former head of her office in the Herzliya Municipality; National Economic Council chairman Prof. Eugene Kandel; health economist Prof. Jacob (Kobi) Glazer; Ministry of Health director general Prof. Arnon Afek; and Israel Medical Association Secretary General Leah Wapner. Opponents included former Ministry of Health deputy director general Prof. Gabi Bin-Nun, Prof. Leah Achdut from the Ruppin Academy, Ministry of Finance deputy budgets director Moshe Bar Siman Tov, and Adv. Adi Niv-Yaguda, a specialist in medical law”. If the Sharap plan would have been approved, it would have permitted choosing a specialist in a public hospital, which would also result in a shorter waiting period. Sharap is paid for by the patient, who may or may not have additional healthcare insurance to cover it. For example, a private visit today in Hadassah Hospital with a senior specialist under Sharap costs 1,150 NIS. Kupat Cholim Maccabi will reimburse a patient if s/he sees a senior physician whose name appears on the approved list in the amount of 80% or 616 shekels, whichever is lower.

Opponents feel that the top doctors are taking private patients during the hours they should be seeing HMO patients and therefore, those unable to pay for private medical care are left out in the cold with substandard care and long lines for an appointment or procedure.

-

A few years ago I blogged about a similar debate concerning Britain's National Health Service:

Monday, May 31, 2010

Money and medicine in Britain's National Health Service

The London Times reports NHS bars woman after she saw private doctor 

Organ donation in China: optimism and skepticism on new policies

The American Journal of Transplantation carried this account of China's moves to end its reliance on executed prisoners for transplant organs, in its 24 Sept 2013 issue:

China's transplantation system has undergone a substantial makeover that may end its longstanding reliance on executed prisoners for organ transplants. A new national program for deceased-organ donation based on Chinese cultural and societal norms was announced by Chinese health officials, who say the new system adheres to World Health Organization (WHO) guiding principles and is compliant with the Declaration of Istanbul. Health officials say that with the new program, the use of organs from executed prisoners will be phased out within two years.

The transplant program is based on pilot trials that took place between 2010 and 2012 in 19 of the 31 provincial regions in China, in which organs were obtained from donors after circulatory death.

According to an interview with Haibo Wang, MD, director of the Chinese Organ Transplant Response System Research Center of the Ministry of Health, that appeared in the Bulletin of the World Health Organization in November 2012, “It is not customary—in term of our culture, law and medical practice—to take brain death as the definition of death in China.”[1] For this reason, the new national program will respect Chinese cultural and social values with three categories of donation: 1) organ donation after brain death; 2) organ donation after circulatory death; and 3) organ donation after brain death followed by circulatory death.

The third category “is an important approach that is very unique to China due to its social and cultural perspective regarding death,” says Jiefu Huang, MD, China's former Vice Minister of Health and current head of the Organ Transplant Committee of the National Health and Family Planning Commission (NHF-PC) of the country's Ministry of Health. “The data from the pilot program indicated that China Category in accounted for approaching 50% of overall deceased donors,” says Dr. Huang.

He adds that “another issue is that the final decision making of organ donation rests on family wishes, regardless of the individual's wish before death. This is to respect the Chinese culture, which is very family centered.”

Waitlists, Registries and Allocation

An important aspect of the program is use of a computerized waitlist developed and maintained by the Chinese Organ Transplant Response System based at the University of Hong Kong, which also runs the Chinese Liver Transplant Registry. The kidney registry is based at the 309th Hospital of the People's Liberation Army, the heart registry at The Fuwai Cardiovascular Disease Hospital and the lung registry at Wuxi People's Hospital.

Although the Red Cross Society of China oversaw donation during the pilot trials, there is currently “a battle for the authority to distribute organs,” said Frank Delmonico, MD, president of The Transplantation Society, in a commentary in the July issue of the journalTransplantation.2 He quoted an article published earlier this year in the Journal of Medical Ethics that said the Red Cross would pay families of the deceased for donor organs.[3] Additionally, the Beijing News reported in July that the Red Cross charges hospitals the equivalent of $16,000 US to receive an organ for transplant.[4]

Another option for organ allocation might be one of the registries. Gabriel Danovitch, MD, director of the Kidney and Pancreas Transplant Program at the University of California, Los Angeles, says the international transplant community strongly advocates “the standards of access, transparency, fairness and justice in allocation that is appropriate for a nation as important as China.” He adds, “I sincerely hope that the Chinese Liver Transplant Registry will be given the opportunity to provide access and transparency of allocation for organ transplants within China.”

Jump to…

KEY POINTS

• China says the new program adheres to WHO guidelines and Declaration of Istanbul principles.
• The program includes three categories of donation, and use of a computerized waitlist.
• Transplant professionals have expressed guarded optimism and areas of concern about the new program.

Guarded Optimism or Skepticism?

While Drs. Delmonico and Danovitch have expressed guarded optimism, they note areas of concern. “One is the continued use of donation by execution,” Dr. Danovitch says. “The second is commercialization of organ donation from both deceased- and living-donor sources.” Dr. Delmonico notes that the financial compensation program for deceased-donor organs suggested in the Journal of Medical Ethics article may undermine the trust of families in the determination of death and a societal trust that organs are being distributed fairly.[3]

Three frequent critics of Chinese transplantation say they remain skeptical. Torsten Trey, MD, PhD, co-editor of State Organs: Transplant Abuse in China, and executive director of Doctors Against Forced Organ Harvesting, says that “with the continuous lack of transparency, the new program is as vague as the Chinese Medical Association pledge to the World Medical Association in 2007,” in which China agreed to end organ sourcing from prisoners. Dr. Trey says he's concerned that “prisoners of conscience, in particular unjustly detained Falun Gong practitioners, are forcibly enrolled into the organ donation program. In order to meet international standards, openness to scrutiny is indispensable. Chinese officials often speak of ending China's reliance on prisoners, yet ending reliance—defined (by them) as less than 50%—does not guarantee a complete end.”

David Kilgour, co-author with David Matas of the 2007 report Bloody Harvest: Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China, is also skeptical. He says he doesn't believe China will phase out the use of organs from executed prisoners in the next two years. “The party-state in Beijing knows that governments, legislators, medical professionals and ordinary people across the world are increasingly aware of its inhuman organ pillaging, mainly from Falun Gong prisoners of conscience in forced labor camps, and thus wants to create for the naive the impression that trafficking in organs will soon end,” he says. “All persons of good will wish it would, but it has now gone on since 2001 and still shows no sign of ending.”

Matas says, “I can't predict the future. I'm skeptical for a number of reasons. One is that they are complaining about cultural inhibitions. But this has never been an issue for anything else with the Communists.” He adds, “Will the numbers in the new system ever be sufficient to replace the numbers they are getting from prisoners? It's not clear. I don't think we should take the assurances of the Chinese government that everything is going to be fine and just give us time. I don't think that's an acceptable answer.”

In China, Dr. Huang says “the success of the new deceased organ donation program is the key to end China's reliance on prisoners' organs.” After the pilot trials, “many hospitals decided to abandon the practice of prisoner organ use,” he adds. “The capacity of the new deceased-organ donation is far beyond the prisoner organs and certainly will ease the donor shortage if we can build an effective OPO [organ procurement organization] system in a relatively short time.”

International Forums

A step toward that development took place in May with the First Chinese Organ Procurement Organization International Forum, held in Shenzhen, China. It was announced that the National Italian Transplant Center will help China build and maintain its national organ distribution and safety monitoring system for donors and recipients, as well as provide training on advanced organ donation practices used in the European Union. A five-year cooperative agreement with the Spanish Transplant Procurement Management and Donation and Transplantation Institute will include training programs with Chinese medical staff in China and overseas.

“In May 2014, one year after the kickoff meeting of the new deceased donor program,” Dr. Huang says, “NHFPC is going to host an international conference to create a platform for international and Chinese transplant communities to exchange knowledge from their own experience and, more importantly, work together to review and improve the design of the new deceased-organ donation program.”

Jump to…

References

• 1
  Fleck F. New era for organ donation and transplant in China. Bull WHO November 2012. who.int/bulletin/volumes/90/11/12-031112/en. Accessed September 4, 2013.
• 2
  Delmonico FL. A welcomed new national policy in China. Transplantation 2013; 96: 3–4.

  • Find it @ Stanford
• 3
  Wu X, Fang Q. Financial compensation for deceased organ donation in China. J Med Ethics 2013; 39: 378–379.

  • Find it @ Stanford
• 4
  Agence France-Press. China Red Cross in cash for organ allegations: media, afp.com/en/node/1000950. Updated July 9, 2013. Accessed September 4, 2013.

German kidney transplant surgeon on trial

Prosecutors in Germany have accused a transplant surgeon of attempted murder, for allegedly manipulating the waiting list to obtain organs for his patients, and thus victimizing those who should have been ahead of them in line to receive the organs in question

Google translate renders the headline as "He killed without being a murderer"

"The surgeon Ayman O. is on trial. He is said to have manipulated information to patients to transplant organs to them. The prosecution sees this as attempted murder, he had taken the death of the other into account. The process in Göttingen will make the system of organ allocation to the test."

HT: Rosemarie Nagel

Child rearing by queuing

In New York City, many of the good things in life for children are rationed by queue: Born to Wait: 
For City Parents, a Waiting List for Nearly Everything

"The first parent lined up at 4 a.m. on a Sunday..

"Twenty minutes later, other parents showed up and a line began to form down Atlantic Avenue in Brooklyn. One father kept a list so that anyone searching for a thawing hot coffee could do so without losing a place in the line. He abandoned that project as more and more people trickled in and the end of the line was no longer visible from the front...

"If waiting in line in the predawn of a January morning for science camp registration sounds crazy, you do not have a New York City child born after 2004. For those children and their parents, especially in the neighborhoods of brownstone Brooklyn, Lower Manhattan and the Upper West Side, not getting into activities, classes, sports teams — and even local schools — has become a way of life.
...
"Havona Madama’s fear of waiting lists led her to start a database to track her 5-year-old daughter’s favorite classes and their registration deadlines. Two years ago, she decided to leave her law practice to turn her research intoKidKlass.com, a hub of information for brownstone Brooklyn about classes, camps and all-important registration dates. The site is still being developed, but she counts 50 to 100 visitors a day who peruse the listings. Still to come, she said, is an “alert” system to let parents know what deadlines they are about to miss.
...
"Technology has fueled the phenomenon. In 2012, the city moved to online registration for its free summer swim classes at its outdoor pools. The number of applicants jumped to 34,134, from 20,393 in 2011, when officials began to introduce the online application. (That year, four pools still required on-site, in-person registration. Most people got in.) Last summer, only 24,532 applications got spots.

"Often, the activities that fill up fastest are the ones that are most affordable and most accessible, like the swim classes. At the Brooklyn Public Library in Bay Ridge, 25 children can be accommodated at the free story-time sessions. Parents and other caregivers routinely show up when the library opens at 10 a.m. to get a ticket for the 10:30 a.m. story times on Mondays and Wednesdays. On a recent Wednesday, tickets were snatched up within five minutes.

"For children, waiting on a list for soccer or missing story time might not be a tragedy, but for parents, winding up on a list can mean having to put life on pause. In the Brooklyn line for science camp, the parents talked about how getting a spot could determine whether they could go to work on particular days, or whether they would have to spend extra money on a baby sitter.
...
'“It’s just a fact of living in the city,” Ms. Flattery said. She has learned not to discuss classes with her children until it is certain they will get in. She also follows a strategy that may add to the waiting lists. “You fill up every class you can, and you drop if you don’t need it. Everyone overschedules — it’s the only route to choice,” she said.

Charter schools and waiting lists in D.C. schools

When school choice procedures result in some children having multiple offers, others must wait for an assignment, which can be taxing. Even in cities that have begun to use single-best-offer school choice systems for the public schools, there can be a lot of congestion if the charter schools aren't integrated into the process. The Washington Post has the story:  Parents struggle with ‘wait-list shuffle’ in D.C. schools


"Thousands of seats change hands in the first weeks of class as students leave one school for another, a quiet migration triggered by the intense competition for a good public education in the nation’s capital.

"This is the wait-list shuffle. Parents say it’s a downside of the city’s school-choice movement — a nationally watched experiment that has given Washington families more options than ever but also has injected a new level of agony and instability into the start of the academic year.

"The change has been spurred by the rapid expansion of public charter schools, which operate outside the traditional school system and under different enrollment rules. As parents try to get their children into the best schools, they can apply to an unlimited number of them. Once admitted, students can hold seats in more than one school.

"Those parents seeking to preserve their options often relinquish the extras only when forced to on the first day of class. Principals then scramble to fill their rolls from long wait lists, recruiting students who are enrolled elsewhere. The cascading effect lasts into October.
...
"There has long been a scrum to win seats in the city’s best traditional public schools, but the rise of charter schools — which now enroll more than 40 percent of Washington’s 77,000 students, a larger proportion than any other city except New Orleans — has helped turn that scrum into a frenzy.

"A growing number of parents are entering lotteries for D.C. public schools, especially for pre-
kindergarten — but they are limited to six applications each year and can’t enroll in more than one at a time.

"The charter school process is a free-for-all: There are 57 different charter schools, and parents can enter as many lotteries as they like. Many track their options with elaborate spreadsheets, relying on word of mouth, test scores and gut feelings to identify favorites.
...
"Each year, lucky students win seats in more than one charter school, or one traditional school and several charters. Other families spend the summer months eagerly refreshing school Web sites, watching their children move slowly up long lists.

"This spring, the waiting lists for charter and D.C. public schools topped out at more than 35,000 names, many of them duplicates. 


"The lists begin to move during the summer, as families settle on choices or move away. Then they accelerate after the first day of school, when principals see who doesn’t show up and turn to their wait lists.

"According to the D.C. Public Charter School Board, 1,141 students withdrew from a charter school within the first month of classes in fall 2011. Another 2,671 entered a charter school within that same time frame.
...
"Parents who take multiple seats say they’re playing by the rules of the game and doing what’s necessary to get what’s best for their children.

"One mother of a kindergartner — who spoke on the condition of anonymity to avoid angering school officials and other parents — spent the first week of classes this fall holding slots at two of the city’s most coveted charter schools, weighing whether she could afford after-school care at the one she preferred."

Long college waiting lists are long shots...

In case you didn't know: Colleges' Tough Waiting Game: Schools Keep Hundreds of Applicants on Reserve Lists, but Very Few of Them Get In

"Carnegie Mellon University in Pittsburgh admitted just six of 5,003 applicants invited onto its waitlist last year. At Cornell University, in Ithaca, N.Y., not one of 2,998 students offered a spot on last year's list was admitted. Princeton, which accepted 2,095 students for a record-low 7.86% admission rate this year, offered 1,472 applicants places on its waitlist. In the past six years, it has taken as few as zero from the list, or as many as 164.

"Many colleges are reluctant to disclose the number of students on their waitlists. Harvard, which admitted a record-low 5.9% of applicants this year, doesn't release the size of its list. A Harvard spokesman said it accepted 31 from the waitlist last year, and between 49 and 228 in the four years prior to that."

"Most schools know by May 1 who has accepted their initial offers of admission. They then turn to the waitlist to fill any remaining slots, a process that is supposed to wrap up by Aug. 1, a deadline set by the National Association for College Admission Counseling. On average, 45% of students offered spots on a waitlist accept, said the Princeton Review."

Boston school choice: waiting lists

The Boston Globe looks at waiting lists for Boston Public Schools. Some wait lists don't move until after the first week of classes, when the fact that some assigned students have left the school district can be verified.

CLASSES IN SESSION; THOUSANDS IN LIMBO: Parents frustrated as children languish on waiting lists

"School opened with almost 10,000 students - nearly 18 percent of the student body - still on waiting lists, trying to get into different schools than they were assigned. Some, like Mayes’s son, were held up because they came late to the process. Others applied on time but were disappointed by their assignments and hoping for better placements.

"Most would never get called. Those who did might wait days or weeks for an opening. Some might not be notified of vacancies until November, forcing families to make agonizing decisions about pulling children out of classrooms they have grown used to.

"Boston’s school lottery is a balancing act. Designed to give every family a chance at getting into a high-achieving school, the lottery lets parents request seats in schools outside their neighborhoods. The intent is to spread opportunity in a city with uneven schools and keep options open for parents, but the unintended consequence, too often, is disruption. Since school started in September, about 750 students moved off waiting lists and into different schools, leaving altered class lists and new vacancies to be filled behind them.

"Last-minute changes are inevitable in a city with a highly mobile population, where hundreds of students move during the summer, but Boston’s assignment system adds - and indeed fosters - additional layers of delay and uncertainty.

"Families who were asked to choose a school last winter or spring were never forced to commit to one. Students could show up - or not - in September. If they didn’t, the district left their seats open for eight school days before releasing the spots to wait-listed students, tying up thousands of seats for the first two weeks of school. The number of no-shows, eight days into this school year, was 2,810.
...
"Why does a school district that starts the assignment process so early not finish it before school starts? Administrators say they can’t start assignments until late in the summer because they have to wait for 3,000 students to finish summer school in August to find out who will actually be promoted and who will have to repeat a grade. The school district’s hotline, which fielded 15,000 calls in five weeks, only has a temporary staff of a dozen and only opened in late August.

“When folks get back from their vacations and hotline staff starts making the phone calls, parents are home, they’ve made decisions, it works,’’ said Jerry Burrell, director of enrollment and planning and support. “Any earlier, it just doesn’t work.’’
*******


Here is the Boston Public Schools student assignment policy for waitlists:

• BPS will create wait lists for all schools where there are more applicants than available seats for a particular grade.
• A student’s place on the wait list is based on the registration period when the student applied, sibling priority, the school choices selected on the application, and a random number.
• No student will have a lower place on a wait list than any student who applied in a later registration round, regardless of priorities. However, within each period, a student’s place on the wait list can change if his/her priorities change, which may affect the placement of other students on the wait list. 
• Families registering for any grade, K0 through 12, may be placed on up to three wait lists. Families who are assigned to their second choice school may be on the wait list for their first choice school. Families assigned to their third choice school may be placed on the wait lists for their first and second choice schools.  And families assigned to their fourth choice school or higher, or who are unassigned (kindergarten only) or administratively assigned (see below), may be on wait lists for their top three choices.
• Families may request that a student be added to any wait list (to a school for which they are eligible to apply). However, students may not occupy more than the number of wait lists prescribed above. Students already on the maximum number of wait lists must go off one list in order to be added to another.
• Any student who remains a Boston resident may remain on a wait list after the beginning of the school year, regardless of whether or not the student attends the Boston Public Schools.
• All wait lists expire at the end of the second marking period (January of the following year).

Coming off a wait list

When seats become available, students will be assigned from wait lists in the following order, beginning with students who applied in the earliest rounds:

If the school has not reached its 50% walk zone target, students are assigned from wait lists in this order:

1. Students with sibling + walk zone priority
2. Students with sibling priority
3. Students with walk zone priority
4. Students with no priorities

If the school has reached its 50% walk zone target, students are assigned in this order:

1. Students with sibling priority (no additional priority for walk zone)
2. All other students (no walk zone)

The random numbers assigned to families during registration will be used as "tiebreakers" among students with the same priorities.

From mid-March through mid-August, as seats become available, children are automatically moved off the wait list into their chosen school. Families receive notification about their new school assignment with a letter sent in a mail.

For kindergarteners after mid-August, if a space becomes available at a school with a wait list, families on the wait lists are contacted in order. Families have 24 hours to decide if they want to attend the school. Families are contacted only at the phone numbers they listed on their registration form. This process continues into the school year through January as seats become available.

For students in grades 1 through 12, if a space becomes available at a school with a wait list, families on the wait list are contacted from mid-August through the end of September. After September, families are only contacted about transferring schools where they are wait-listed after marking periods (mid to late November and late January). Families have 24 hours to decide if they want to attend the school and families are contacted only at the phone numbers they have listed on their registration form.

All lists, regardless of grade, expire at the end of the second marking period (January of the following year)."

Wait-lists in college admissions

Inside Higher Ed reports:
 "at the annual meeting of the National Association for College Admission Counseling -- colleges' wait-list practices have become an issue of concern for many high school counselors. One session focused on the issue, and NACAC's Assembly voted for a formal study.

"The main concern among counselors was the lack of transparency surrounding how institutions manage their lists and why they operate them as they do. While most of the admissions process is governed by fairly clear rules laid out by the association, there are few rules governing the time between May 1 and August 1. Counselors said they have noticed a trend of more students are getting put on wait lists every year, and many said they hear horror stories about students being blind-sided with quick deadlines or inadequate aid offers months after they gave up hope of getting into their preferred institutions.
...
"Wait lists -- where institutions do not immediately deny a student admission but defer the decision until other students have either accepted or declined admission -- have become more prominent in recent years, admissions officials said. According to NACAC’s annual admissions trends survey, 39 percent of colleges responding to the survey reported using wait lists in 2009. Of those, 47 percent reported increases from the year before, and 51 percent reported increases in the number of students admitted off wait lists.
...
"The association's Statement of Principles of Good Practice lays out few rules regarding what institutions are allowed to do when forming a wait list or offering students acceptance off one. There are no rules or best practices governing the size of wait lists or how long students should be given to make a decision. Weede said the outcome of Talmage's proposal could be new recommendations.

"Talmage said he was motivated to bring forward the resolution after an incident involving one of the students he counseled. The student was placed on the wait list at his first-choice institution and told in May that the university would no longer accept anyone from the wait list. He accepted an offer from another institution only to get a call from his first choice at 9:30 a.m. one day in June, telling him he had until noon to make a decision.
...
""My sense is that the wait list is one of the least-studied -- and perhaps least-analyzed -- parts of the college-admissions process," Trout said in the opening remarks to his session Friday.
...
"Sometimes the stories involve institutions pumping up their yield numbers by placing a large number of students on wait lists and then only selecting students they know will enroll. Other times they revolve around need-blind institutions no longer ignoring need once they start pulling from the wait list.

"Still others involve students like Talmage's who are given very little time to make a decision, or students who are admitted off several wait lists in succession, losing enrollment deposits at each successive institution.
...
"For his session Friday, Trout asked four institutions -- the University of Notre Dame, the University of Wisconsin at Madison, Grinnell College, and Texas Christian University -- to supply data about and discuss how they use wait lists.

"The number of students offered spots on wait lists ranged from 500 to almost 3,600, and the number offered admission ranged from 140 to 0.

"Institutions that use wait lists said they help control for disruptions in the student market that could hurt an institution's bottom line. “It’s a process of managing uncertainty in an uncertain field,” said Seth Allen, dean of admission and financial aid at Pomona College.

"Butler University provides a good example. The institution saw applications increase 41 percent this year -- likely due to the performance of its men's basketball team in the NCAA tournament, where it reached the finals for two consecutive years -- along with an increase in student quality, Weede said. The institution saw a significantly lower yield than it had in previous years, and ended up offering admission to 650 members of its 720-person wait-list.

"Other times only a small number of students are actually offered admission off a wait list. In 2011, the University of Notre Dame placed 1,905 students on its wait list -- 1,632 of whom chose to remain on the list – and only accepted seven students off the list. None of the 3,600 students offered a spot on the wait list at the University of Wisconsin at Madison in 2010 received offers of admission.

Waiting lists

In the Chronicle of Higher Education, Toni Adleberg, a recent NYU graduate compares her experiences on the waiting list for graduate admissions, and the wait for a new liver: They'll Just Have to Wait.

Kindergarten applications in Manhattan

A Frenzied First Day for Applying to Private Kindergartens
"As the new school year begins, another annual rite of Manhattan education commences: the crush of applicants to private nursery schools and kindergartens, many of which make applications for the following school year available the day after Labor Day.

"So parents swamped the schools’ Web sites and phone lines on Tuesday, reloading and redialing until they got through, and in some cases even turning in the paperwork before noon.
...
"At the 92nd Street Y and Epiphany Community nursery schools on the Upper East Side, just getting an application was a race against time. At Epiphany, applications became available online at 8 a.m. for about 30 slots next year. By 9 a.m., parents were being put on the waiting list — to get an application — and roughly 350 applications had been downloaded.

"Early birds had a big payoff: all who complete Epiphany’s application process are guaranteed an interview, said Wendy Levey, the director of the school. “I will interview parents all night if I need to,” she said.

"At the Y, candidates must call to set up a tour to be eligible for an application. The telephone lines opened early Tuesday, and by midmorning the tours were booked for 2- and 3-year-olds."

College admissions statistics, sampled for 2010-11

The NY Times offers a table of statistics (which I can't copy properly for some reason) and an accompanying story about the admissions results from some selective colleges, including information on

Applicants

Admits

Admit Rate

Offered Spot on Wait List

Accepted Spot on Wait List

Wait List Admits

Enrolled

Total Admits Attending (Yield)

The story says "The percentage of students accepted at many of the nation's top institutions hit new lows, while waiting lists reached new heights, says Barmak Nassirian, executive director of the American Association of Collegiate Registrars and Admissions Officers. "Mr. Nassirian points to the economic downturn as fueling uncertainty among colleges about how many accepted students would actually attend — the so-called yield. "The underlying method by which families have historically paid for college was basically obliterated by the triple whammy that this recession has delivered,” he says. "As a result, colleges had to hedge their bets this year: some offered a waiting-list spot to more than three times as many students as their entering class, leaving hundreds, even thousands, of students dangling, sometimes into late summer. " Meanwhile, at the University of Iowa, Undercounting Freshmen, Iowa Scrambles for Room "IOWA CITY — Like an airline overselling a flight, the University of Iowa extended admission this year to several thousand more applicants than it could accommodate on campus in this fall’s freshman class. "While nearly every university overbooks each year, relying on sophisticated algorithms that predict just how many admitted students will probably go elsewhere, Iowa officials were surprised to learn this spring how far off they were in their math. This fall’s freshman class is likely to have more than 400 more students than last year’s, an unintended increase of about 10 percent, for a total of just over 4,500. " And at Harvard, Harvard College Admits 12 Fall Transfers "After two years during which no transfer students were admitted, 12 new students have arrived at Harvard as the latest additions to the classes of 2012 and 2013. "Out of 614 transfer applicants, 13 were accepted and 12 decided to attend, according to Dean of Admissions and Financial Aid William R. Fitzsimmons ’67. ... "The students—four sophomores and eight juniors, according to transfer student Sarah L. A. Erwin ’13—come from a variety of universities around the world, including small private schools like 26-student Deep Springs College, research universities like Brown and Georgetown, and international schools such as McGill in Canada and Pontificia Universidad Catolica in Chile."