Creating Your Residency Rank List

Toward the end of the interview season you will be confronted with the daunting task of creating your rank list of programs for submission for the Match in the spring. Even though you are still in the interview process, it is never too early to start thinking about how you will eventually compile your list.

It is important to remember that your rank list is an extremely important and highly personal thing—it will essentially determine where you will spend the next three years (and possibly more), and the choices you make through your list will have a profound impact on many aspects of your life. It is no wonder that creating your list can be incredibly anxiety-provoking, particularly since the structure of the Match makes it feel as though you only have limited control of the process (which is usually an uncomfortable feeling for people going into internal medicine!). However, developing your list can also be part of a very exciting process in deciding the next step in your life and career. 

Here are some important things to consider when thinking about creating your rank list:

• It is extremely important to understand how the Match works. Much of the anxiety surrounding the Match lies in the mystery surrounding the matching algorithm. The National Residency Matching Program (NRMP) has a detailed explanation of the process, including examples of how the structure of the rank list may affect Match outcomes. It is particularly important for people planning to participate in the couple’s match to understand how this works as it differs significantly from those who are matching individually. The Match process is extremely fair and tends to favor applicants (vs. programs), but it works solely off of both sets of rank lists and does not consider other factors that you will ultimately use to create your list. But knowing the mechanics of the process will help inform the creation of you own list and hopefully alleviate some of the anxiety associated with how the Match works.
• It is imperative that you seek out the advice of advisors and/or mentors at your school who have experience with the Match and can help in the process of putting together your rank list.  Most departments of medicine have people particularly skilled and dedicated to this, and this often is the same person who wrote your departmental/Chair’s letter (such as the Vice Chair for Medical Education, residency program director, clerkship director, or others). These individuals usually have a good sense of what many residency training programs are like and your level of competitiveness for different programs. They are also usually aware of your specific circumstances, and their advice can be invaluable in providing a realistic perspective about your options and the appropriate structuring of your list. If you haven’t been in contact with them since you began your interviews, you should begin to involve them in your rank list deliberations.
• Always remember that creating your rank list is a complex proposition involving not only you, but also virtually all of the significant others in your life. Although they can’t make rank list decisions for you, their input is invaluable since they will also be profoundly affected by your choices.

As you start to envision what your rank list might look like, here are some things to keep in mind:

• For programs in which you have great interest, do not rely on verbal discussions about where they might rank you that you may have had with that program during your interview. Although it is a violation of NRMP rules for either an applicant or a program to solicit information about how the other will rank them, it is not a violation for either party to volunteer this information. However, no verbal indication of potential rank position is binding, and a program may not ultimately rank you where it was suggested they would. From a program's perspective, the structure of their rank list is complex and typically does not occur until late in the process and long after your interview; therefore, any expression of interest on the part of the program is difficult to interpret when constructing your own rank list.
• You should rank programs in the specific order of your true preference. The matching algorithm does not consider other factors that may affect your personal decision of which programs are most desirable to you.
• The ideal length of your rank list depends on a number of factors, including your competitiveness and the competitiveness of the programs to which you are applying, the type of programs to which you are applying (such as academic vs. community-based and urban vs. rural), among other factors. However, there are some general considerations that apply:
  • Do not underestimate yourself. Even if you are not the strongest candidate on paper for a particular program but believe it would be the best match for you, ranking that program highly is a reasonable option. It is difficult to know where you may be ranked by a program, and placing a “stretch” program on your list is of little harm provided your overall list is consistent with your overall competitiveness.
  • Don’t plan to make a rank list that is very short. Even if you have a good idea of the program or programs on which you want to focus, and even if you believe you are a strong candidate for your desired programs, you should avoid listing only a few. In general, students who end up being unmatched submit rank lists that are shorter than those who do match.
  • It isn’t necessary to make your rank list too long. Remember that most students match into one of their top 3 programs, and a carefully developed list that accounts for your interest in specific programs, the type of programs in which you are interested, and your competitiveness for different programs is the best way to approach your overall rank list length. Your advisors and mentors can be of great help in tailoring your list to your own circumstances in terms of length.

Do not list programs that you absolutely do not want to consider. By placing a program on your rank list, you are indicating that you are willing to go there if matched. If a particular program is not acceptable to you, you should not list it as this creates the possibility that you might match there. Although there is a tendency to want to place “safety” programs at the bottom of the rank list to avoid not matching, realize that it may be better to be unmatched in the initial process than end up at a program you really don’t want to attend.