Making Your Rank List
Interview season is OVER. It's almost time for MATCH DAY and now the NRMP rank list is open. Dr. Grace Oliver joins us on the blog to give some tips and tricks on making your rank list. How do you prioritize where you want to spend the next three to seven years of your life? Do you rank a program? Do you not rank a program?
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While most of us wouldn’t call it the most wonderful time of the year, the official reopening of the NRMP rank order lists signifies one of the last major hurdles of medical school. For all the talk of “when you know, you know” and “go with your gut,” it often isn’t so simple to actually sit down and put every program in order of preference knowing that each little change could very well change your life. But I promise you that the answers are already inside your brain, you just have to take some time here to think and get to them. So take a deep breath and let’s get started!
When I first sat down to make my rank list, I could easily identify my favorite and least favorite programs. What was challenging was how to order all of the programs in the middle, or how exactly to order programs when I loved all of them. If you’re in a similar situation, I recommend the method of breaking them all down first into four categories:
I love this place
Solid choice but not my favorite
Pretty good but I have concerns
Better than not matching
Think carefully first about what it means for a program to be worse than not matching the first round for you, factoring in things like the relative competitiveness of your application for your specialty of choice, the SOAP, and the widening gulf between the number of available residency positions and the number of people applying for them. After all of that, a program doesn’t even fall into category #4 for you: do not rank it. I mean it.
Next, let’s get some perspective on the ultimate importance of having each rank list in the exact right spot to the point that you’ve agonized over it and rearranged it 50 times. At the end of your training:
YOU WILL STILL BE A DOCTOR.
This will be true whether you end up at your #1 ranked residency or your very last choice, and this is the goal. I want you to be happy with where you go for residency, and there was a reason that you selected your favorites as your favorites in the first place, but the main goal at the end of the day is to be a doctor. You didn’t go through everything you’ve gone through so far on the condition that it’s only worth it if you got to match into one of your top 3 residency programs, right? It’s bigger than that.
Now back to the list, because you have to do it to match at all. Go with your gut feeling for these overall categories. If you struggle to place programs into the categories, refer back to your notes from interview day, diary entries, or even talk to friends and family to try to refresh your memory regarding how you felt about that program. I urge you to focus on your instincts and your overall impression, not the minutiae of the call schedule or the parking fees.
For me, the biggest factors in structuring my list were how I felt I fit in with the residents and faculty, the diversity of the patient population, and flexibility within electives and research. Other common deciding factors may include: proximity to family, cost of living, prestige of the program, in-house fellowship opportunities, etc. There is no such thing as a bad reason to rank a program highly as long as it is genuinely something you know will bring you happiness and fulfillment. It’s tempting in these uncertain times to be passive and let small objective details about each program decide your list for you—to think “well, program A has a gym in the hospital but program B has $500 a year more in salary so I should probably rank B higher.” Whatever elements of each program you choose to factor in to your decision-making, make sure that it is only because you value that thing, and not because it “sounds better” or because you think you’re “supposed to” value it. What will get you through those difficult call nights in your future: is it the food stipend, your co-residents, the world-renowned name on the outside of the building..?
Once you have your categories in place, I want you to apply the same values-based decision-making to the order within each category. When you decide to place one program over another, ask yourself why and be brutally honest about whether this reasoning is in line with your values or not. If it is, then go for it. Some people have an easier time doing this with an Elo ranking tool, like the one found here. This pits two programs against each other at a time, and at the end based on these pair preferences it spits out an ordered list of all options.
When you have an ordered list, I want you to look at it very carefully. I want you to show it to a very trusted person who knows your values and supports you. I want you to sleep on it. After all of this, if you don’t feel a predominant sense of relief and ease, I want you to nudge the list around until you do. Last step: certify, submit, and keep busy until Match Day.
You are the one who must attend the residency you match into—nobody else. So don’t worry about how others might rank your same list of programs, or if they would prioritize details in a different way than you did. Making decisions in accordance with your own values and priorities is about the closest thing I can offer you to a recipe for happiness. This list is for you and about you, and this is about the most control you get in this whole process—so seize it.