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Abstract

This opinion paper argues that threshold-based lottery admissions offer a strategically necessary response to equity challenges, enrollment pressures, and evolving definitions of merit in allied health education. Current admissions models, whether traditional or holistic, often reflect underlying tensions between academic metrics and institutional missions and may unintentionally privilege certain applicant groups. As demographic shifts and the looming enrollment cliff intensify these pressures, allied health programs must reconsider how they define and identify admissions excellence. Drawing on examples from other sectors and recent literature, this opinion piece argues that a threshold-based lottery system, applied to applicants who meet baseline academic criteria, can promote fairness, transparency, and sustainability without compromising standards. The paper introduces the CLEAR Admissions Framework as a conceptual tool to guide implementation, emphasizing the importance of defining success outcomes, identifying predictive variables, and establishing data-informed thresholds. Rather than attempting to eliminate bias entirely, the model encourages programs to use mission-driven weighting to reflect unique values and communicate institutional priorities to prospective students. The discussion also considers faculty habitus, particularly the tension between gatekeeping and transformative orientations, and how a lottery-based model might offer a middle path that honors both rigor and representation. Ultimately, reimagining admissions is not about lowering standards but about aligning all interested parties with the evolving goals of the allied health professions. A lottery-based approach, grounded in evidence and mission, offers a promising alternative for programs seeking to build a more inclusive and resilient healthcare workforce. This perspective is intended to prompt discussion, pilot exploration, and reconsideration of admissions assumptions within the allied health community.

Author Bio(s)

LaDarius "LD" Woods, PT, DPT, PhD, CSCS is an associate professor and Director of Access and Engagement at the University of Alabama at Birmingham. He is a licensed physical therapist in the state of Alabama.

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