Advice for your Rank List

[Robbins]

With interview season all but over, I'm sure all of you are ranking and re-ranking the programs where you interviewed. If you were like me, it was fairly easy to pick which programs you wanted to put at the top of the list, which you wanted to put at the bottom, and which you DNR. Specifically ranking two programs at the top or bottom of your list is much harder. I have no advice for you about how to resolve this issue, but I do have some advice about DNRs.

When you moved from your M2 to your M3 year, you left a period of your training where you were being evaluated on an objective basis to one where you were being evaluated on a subjective basis. Still, you had opportunities (your USMLE exams) to prove your competence against an objective standard...and unless you were a completely obnoxious screw up, there was little chance that you wouldn't progress to graduation.

Residency is a little like your M3 year, but the stakes are higher. Evaluation and advancement are almost completely subjective. Yes, there are yearly examinations, but programs are free to emphasize or de-emphasize the results as they see fit. One person with one opinion can sabotage your career if he or she has the wrong title on the office door. Nobody ever believes that it will happen to them, but it happens and more frequently than you care to believe. Somewhere between 1% and 10% of residents who start training do not complete it. For instance, in family medicine, the percentage is around 7%. First years get terminated. Fellowship bound seniors get terminated. Chiefs get terminated.

You have come a long way, worked hard, and incurred a substantial amount of debt in doing so. Do not risk your future careers by ranking a program that is known to be malignant. Also, keep your eyes open for programs that are, but word hasn't gotten out yet. The best way to secure your future is to DNR any program at which you felt that potential conflicts or problems might exist - or at which you met or interviewed with someone who you found to be arrogant, egotistical, or otherwise rubbed you the wrong way. Also, if a program has let a lot of residents go in a short period of time, that is a huge red flag.

After match day you lose essentially any power you had to control your destiny, and you will not regain it until you finish residency.
Choose wisely.

(...and no, I haven't been terminated, but I've seen too many of my colleagues suffer this fate.)

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[kdburton]

7%? That sounds high, but either way the odds aren't against you as long as you progress as expected and get along with your superiors. If you have interviewed at places that are know for terminating residents then at the very least rank them at the bottom of your list. If you match there then you can tell yourself "Hey if I didn't rank them I wouldn't have matched at all." Its significantly harder to match the 2nd time around if you didn't match the first time. If you're an MS4 who is finished up with your interviews and contemplating the order of your rank-list then you are pretty much maxed out in terms of your educational debt unless you decide to take out a loan for residency relocation, so increasing the chances of never securing a position (no offense, but if you don't match in family med I'm not sure what you're going to be competitive enough to scramble into) in a residency program is certainly not a smart move financially. The ONLY reason you should not rank a program is if you would RATHER NOT MATCH than match at that program.

 

[cpants]

7%? That sounds high, but either way the odds aren't against you as long as you progress as expected and get along with your superiors. If you have interviewed at places that are know for terminating residents then at the very least rank them at the bottom of your list. If you match there then you can tell yourself "Hey if I didn't rank them I wouldn't have matched at all." Its significantly harder to match the 2nd time around if you didn't match the first time. If you're an MS4 who is finished up with your interviews and contemplating the order of your rank-list then you are pretty much maxed out in terms of your educational debt unless you decide to take out a loan for residency relocation, so increasing the chances of never securing a position (no offense, but if you don't match in family med I'm not sure what you're going to be competitive enough to scramble into) in a residency program is certainly not a smart move financially. The ONLY reason you should not rank a program is if you would RATHER NOT MATCH than match at that program.

Yes, I agree with this. The only reason not to rank a program is that you would rather not be a physician in that specialty than train at that program. If you truly feel that it the program is so malignant that you could not successfully train there...AND you would rather reapply or do another specialty than train there...then by all means do not rank it. Otherwise put it last and hope for the best.

 

[jackets5]

question about the match process. Say a program has 15 spots in their residency, they rank me 13th. I have 12 interviews and rank this program number 12 on my rank list. Say i do not match at numbers 1-11 on my list am i guaranteed to match at 12 since they ranked me in their top 15.

They way im thinking if any program ranks you to match, you are guaranteed to match as long as you rank that program, am i correct?

 

[alwaysaangel]

question about the match process. Say a program has 15 spots in their residency, they rank me 13th. I have 12 interviews and rank this program number 12 on my rank list. Say i do not match at numbers 1-11 on my list am i guaranteed to match at 12 since they ranked me in their top 15.

They way im thinking if any program ranks you to match, you are guaranteed to match as long as you rank that program, am i correct?

You are correct, you would get that spot because you are high enough on their list.

However, "ranked to match" means different things to different programs. Don't trust anyone in this process. "Ranked to match" does not mean "Guaranteed to match." Programs lie.

 

[cpants]

You are correct, you would get that spot because you are high enough on their list.

However, "ranked to match" means different things to different programs. Don't trust anyone in this process. "Ranked to match" does not mean "Guaranteed to match." Programs lie.

Exactly. So you should still rank any other programs you interviewed at below the program who told you that you are "ranked to match".

 

[Law2Doc]

question about the match process. Say a program has 15 spots in their residency, they rank me 13th. I have 12 interviews and rank this program number 12 on my rank list. Say i do not match at numbers 1-11 on my list am i guaranteed to match at 12 since they ranked me in their top 15.

They way im thinking if any program ranks you to match, you are guaranteed to match as long as you rank that program, am i correct?

Yes, if they are being honest with you. But there's no reason they have to be honest with you, and in fact the match rules prohibit any sort of tacit agreements between programs and applicants, so they are free under the rules to be unscrupulous. So some programs tell every good applicant they are likely to match just like some applicants tell multiple programs "you are my first choice". Everybody knows it's just folks blowing smoke and nobody puts much stock in it.

Just rank all the places you would consider going in the order that you would like to go. And for those you don't want to end up at, think really hard as to whether taking your chances in the scramble is really better than suffering through such a program. Although there are always a few success stories, often you can end up with something really malignant and undesirable in the scramble -- a lot of slots get passed over for a reason.