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 Airbnb as we travel near and far for interviews. Finally, as we turn the corner into February, it becomes real. In just a few weeks, our rank list is due. This is the final process 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 to oneself—prestige, location, and cost of living, just to name a few considerations. Throw in a couples match or a prelim year, and you have really added some layers to your tough decisions. 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.
As I am going through the process of ranking programs myself, I have been researching the ranking and matching process. How can I, as an applicant, optimize my chances of matching? And not just that—how can I optimize my chance of matching at a place I actually want to be? Here are a few tips that I’ve gathered along my journey to making my rank list:
Myth: Rank all of the programs you interview at.
Truth: Rank only programs where you would be content to train.
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 that piece of paper can be any program from your rank list. Hence you may have to ask yourself the tough question for every program you rank: Would I rather not match than be obligated to train at this location?
Myth: Rank only your favorite programs.
Truth: A shorter rank list increases the risk of not matching.
In the context of myth number 1, it becomes imperative to point out that it is still important to rank as many programs as possible. If you’d be “okay” 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 this a risk I am willing to take?
Myth: Rank programs in order of where you think you’ll match.
Truth: Be sure to 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. Also, as humans, we are likely to feel more positive emotions when in an environment where we think people like us. It gets confusing—sorting out how we really feel versus how we feel about how they feel. It is important to come back to the facts of the match algorithm. Student rankings of programs prevail over program ranking of students. Therefore, it is our obligation to ourselves to be honest about where we desire to match. Who cares if we match at our first, second, or third place? At least we were honest and did our best to get what we want.
Myth: “Go with your gut” versus “Be systematic.”
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 sum to a score assigned to each program. Others say they follow their gut instinct, their “sense of belonging”, and rank with their hearts. I say—it is up to you. 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, you can do so. Just figure out what is important to you, and own it without regrets.
There exists no doubt that making the 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 February 20th.