It’s something we try to put off thinking about until the very end. September arrives, and we submit our ERAS applications with a sigh of relief. October rolls in, and with wide eyes and big smiles, we see the interviews trickle into our inbox. The winter months are filled with overstuffed suitcases, airplane pretzels, and Airbnbs as we travel near and far for interviews.
Finally, as we turn the corner into the new year, it becomes real. In just a few weeks, our rank list is due. This is the final step of the residency interview process, and it culminates with the NRMP Rank List for Match.
Ranking programs is an intensely personal process. It’s a time of introspection to figure out what is really important—prestige, location, and cost of living, just to name a few considerations. Throw in a couples match or a prelim year, and you have even more layers to consider.
Do not take the NRMP Rank List lightly—this ultimately determines where you match and will be spending the next 3-7 years for residency.
Learn how you can optimize your chances of matching, as well as how you can improve your chance of matching at a program you actually want to be matched with. Here are five myths about creating your Rank List Order, including the truth about what you should be doing instead.
1. Myth: Rank all of the programs you interviewed at.
Truth: Only rank programs where you would be content to train.
You do not have to include every program you interviewed at, but you might choose to do so depending on how you feel about the programs. Putting a program on your rank order list (ROL) creates a binding commitment if you match there. If you are opening an envelope on Match Day, you have to accept that the name on the piece of paper can be any program from your rank list.
Ask yourself this tough question for every program you rank: Would I rather not match than be obligated to train at this location?
2. Myth: Only rank your favorite programs.
Truth: A shorter rank list increases the risk of not matching.
In the context of myth number 1, it’s imperative to point out that it is still important to rank as many programs as possible. If you’d be okay with matching there, rank it.
Evidence shows that a shorter rank list correlates to a higher risk of not matching. With every program you choose not to rank, ask yourself: Is not matching a risk I am willing to take?
But let’s repeat—don’t rank programs you wouldn’t want to complete residency at. If the idea of improving your skills, completing research, or pursuing another endeavor is more favorable than being matched at that program, don’t rank it.
3. Myth: Rank programs in order of where you think you’ll match.
Truth: Rank programs in order of your true preference.
It is tempting to rank a program highly if you think the program likes you. It can be a pride issue; we all want to say we matched at our number one choice. Therefore, we are tempted to rank “attainable” programs highly. We’re also more likely to feel positive emotions in an environment where we think people like us.
Sorting out how you feel versus how you think the program feels is confusing, but it’s important to come back to the facts of the match algorithm. Student rankings of programs prevail over program rankings of students, so it’s our obligation to ourselves to be honest about where we desire to match. What matters most is that you match with a program you feel comfortable spending the next 3-7 years.
Trying to outsmart the algorithm by playing games doesn’t make sense because it’s already designed to give students the best match possible.
4. Myth: It’s okay to make last minute changes.
Truth: Making changes last minute can lead to rash decisions and regret.
Ranking your residency programs is a big decision. It’s important to weigh multiple factors to ensure you get a result you’re satisfied with come Match Day.
Rushing the process or making last minute changes can lead to regret. You want to come out of Match Week, no matter the result, knowing you gave it your all and put time and care into every aspect of the residency application process, including your ROL.
5. Myth: Going with your gut is better than a systematic approach (or vice versa.)
Truth: It’s a combination of both, but most importantly, it’s something no one else can decide for you.
Some people argue for the twenty column spreadsheet, with each column weighted to create a score assigned to each program. Others say they follow their gut instinct or “sense of belonging” and rank with their hearts.
The truth is your decision must be based on a combination of factors. If your partner has a job in a certain area, perhaps location is the most important thing, and you can adapt to other factors. If you want to buy a house for your spouse and kids instead of living in a one bedroom apartment with a roommate, maybe you will choose a small town instead of a big city. And if you simply want to pursue the best quality training possible, rank possible programs with that top-of-mind.
Take time to figure out what is important to you, and own it without regrets. Put in the research and be honest with yourself about what matters most to you.
Making the Decisions That Are Right for You
There is no doubt that making your rank list is a daunting task. The unknowns are scary, but all we can do is put our best foot forward. So, be honest, be brave, be humble, and remember to hit “Certify” before the February deadline.
Med School Insiders offers one-on-one advising that pairs you with a physician advisor who best fits your specific needs. We’re here to answer all of your questions and help you choose the path that best aligns with your interests and desired outcomes.
If you’re still in the midst of applying to residency, utilize our ERAS Residency Application Guide. The Med School Insiders blog is filled with articles for medical students, including a wide range of residency application resources.