It’s January, it’s Medicine Mondays, and it’s time to give some serious thought to your Rank Order List for The Match…

Take a deep breath, pour some coffee and read on…

Stock Photo from: Pixabay

First things first, if you haven’t already, please go back and read some of my prior posts:

4th Year, ERAS and the NRMP

Residency Interviews

Traveling for Interviews

Mid #Match2017 Evaluation

How do I decide where to rank places?

The most recent post Mid #Match2017 Evaluation touched upon some notes you should have been taking during all those interviews you went on.

To reiterate, I would recommend you use at least these criteria when deciding your rank order list:

Location – this may be important for some, wanting to be near a family or loved one, or in a specific city. However, this may less important or even unimportant for someone who has no particular ties to anywhere and simply wants to get the best experience/education. You may need to subdivide this into “Cost of Living” and “Weather”, etc. depending on you.

Lifestyle – not all programs are made equal. Some programs stack the early years with call and it trails off during the later years (front-loaded program). Others may divide call relatively equally throughout the years. What do you prefer?

As you probably suspected, this section will likely be subdivided into call. How exactly is call? q4 call at two different programs may not be the same at all. For example, if you are q4 overnight at Program 1, but also cross-covering 2 other floors at the same time. That is not the same thing as q4 overnight only covering your floor at Program 2.

Also, how much is the residency salary? Is that good for the area (based on cost of living)? Are there opportunities to moonlight?

Education – how often do you get didactics? Is it a “didactic day” or is it “noon conference” everyday? Which fits you better? Are the conferences primarily resident-run, fellow-run, or is an attending always giving conference? How often is Grand Rounds? Is the opportunity for first author research available? Has any resident ever received a grant before? What fellowships are available?

You can subdivide this into “Didactics”, “OR Time”, “Research”, Preparedness for Real World”, and “Fellowship Opportunities”, etc.

Prestige – like it or not, training at a big-name program program may open some doors in the future. For some specialties, this is also pretty important. Any specialty that can open its own practice and requires out-of-pocket pay will have patients who want to “get their money’s worth”.

For example, dermatology and plastic surgery may need to market themselves to get clients. Having a big name institution behind you gives you some degree of prestige starting out. When you apply for your first job, having a big name on your institution could potentially push your application into “interview” pile in a competitive job market, or competitive location.

For some, this may be very important. For others, this may be completely unimportant.

Resident Happiness – make no mistake, residency is tough. How do the residents look? Do they seem genuinely happy? At the interviews, try to talk to as many residents as possible. There is usually one or two people who can’t hide their disdain for the program, no matter how hard they try. Those are the people you want to talk to. 

Remember how I advised you to make note of programs that “felt right” or “felt wrong”? I hope you made note of them, because now after going on all the interviews you’ve been on, you probably don’t remember who said what or which program director was at which program.

In general, I think that the “felt right” or “felt wrong” feeling is something that can’t really be explained. It has to do with the general culture of the program as well as just an overall gut feeling. This is the most subjective part of the match list, but I still believe it should have significant weight. How much weighting it deserves is up to you.

I also hope you made good use of email to talk to the residents at your interviews that you didn’t see much. Often the residents you see the least will have the most to say.

With all this information in front of you, make a rank order list. This will be the first draft.

Rank your programs in order of your preference. 

Where you went for the pre-interview dinner shouldn’t matter. Unless the program is sends the residents there every Thursday for Happy Hour or some other very highly unlikely scenario.

Don’t rank programs higher just because you have a good chance to match there.

This seems to happen every year. Some medical students rank a program 1st because they think they will match there, in fear that they won’t match unless they rank it first.

That’s not how you should think.

Rank a program 1st if it’s your first choice, and so on.

If you don’t match at your #1, your #2 becomes your #1. However, if you match at your #1, it stops there. 

From the NRMP: Run A Match

“Ford, Davis, and Eastman used The Match to their advantage by ranking all acceptable programs to maximize their
chances for a match. They, in addition to Chen, were smart to rank programs in order of preference and not based
on where they believed they might match.” (emphasis mine)

For some reason, people forget this when it draws close to match time.They end up ranking on beliefs rather than than preference. Please don’t do that.

MY ADVICE

Please remember to give yourself a lot of time deciding between each individual slot on your rank order list:

Your #12 versus #13 choices are just as important as your #1 versus #2. You have no idea where you may end up on your rank order list.

After you make your first rank order list, leave it as is for a solid week. 

Don’t touch it. Don’t think about it. Forget it exists. Enjoy 4th year.

After that week, make your rank order list AGAIN, without looking at your first rank order list

Now compare both lists. What, if anything, changed? Now ask yourself, why did it change?

Now, put them both away for another few days. Pull them both out again after doing something relaxing.

I’d recommend sitting down with a glass of wine or some Johnnie Walker, or whatever your poison is.

If you don’t drink (which is fine), then pick a comfort food. Pizza, ice cream, whatever you want. Sit down with what makes you comfortable in your PJs and look at the lists again.

Now create a 3rd rank order list in this calm state looking at these 2 separate lists.

The next day, compare all three lists and see what changed. Find what you really want and make THE list (the 4th list).

Take this new list (4th list) and put it into ERAS and certify this list before February 22, 2017.

Ideally, certify at least a week before. ERAS always gets hit hard the night before the match… and may go down. You don’t want that stress.

PLEASE, PLEASE, PLEASE:

DO NOT change this list (4th list) unless you have an epiphany. An “I’ve made a huge mistake” moment.

DO NOT to log into ERAS February 21, 2017 and make huge sweeping changes to your rank order list.

TL;DR

Rank programs in order of your preference with the categories I described.

Give each slot a lot of thought. Your #12 versus #13 choices are just as important as your #1 versus #2.

Make the 4 lists I describe above.

Certify your 4th list at least a week before the deadline.

Please do NOT to log into ERAS the night before the deadline and make huge sweeping changes to your rank order list.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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