Tips on Ranking Residency Programs

photoResidency interviews wrap up in late January, and by mid-February, you should already have an ordered list of how you are going to rank the programs you interviewed at. How you order your Rank Order List (ROL) can make a difference in where you go for residency. Here are some important tips on what to do and not to do when it comes time to ranking residency programs.

1. Rank programs in the order in which you want to go, NOT in the order in which you think you’ll likely match!
Say you interviewed at 10 residency programs. At “Backup Medical Center,” you interviewed well, but liked the program the least out of all the hospitals you visited. At “Favorite Medical Center,” however, you didn’t interview particularly well, but you loved the program and it is your favorite. You have a gut feeling that Backup Medical Center loved you and is going to rank you highly but Favorite Medical Center isn’t going to rank you. You are desperate and haunted by the fear that you will not match at all, and so you rank Backup Medical Center #1, thinking that this will increase your chances of at least matching somewhere. Match day comes and you match into Backup Medical Center.

If you didn’t rank Favorite Medical Center as your #1 choice, how would you know you wouldn’t match there? Perhaps Favorite Medical Center actually did love you during the interview and you didn’t know it, and you would’ve matched there if you ranked it #1 instead of Backup Medical Center. Even if Backup Medical Center ranked you #1 on their list, as long as Favorite Medical Center ranks you high enough to Match, and you rank Favorite Medical Center higher on your list than Backup Medical Center, then you will have a higher chance of matching into Favorite Medical Center than Backup Medical Center. In another scenario, if Backup Medical Center ranked you #1 on their list, but you rank them #10, and for whatever reason, your #1-9 choices do not rank you at all, then you will still match into Backup Medical Center because you are #1 (or whatever high rank) on their list. No other candidate with a lower rank than you on a program’s list can take your spot (no matter how you rank the program), unless you match somewhere else higher on your list.

So, whichever way you order your Rank Order List, your chances of matching somewhere will not change. What changes is where you match, so don’t worry about how a program is going to rank you when putting together your rank order list. Just rank your programs according to the order in which you want to go, NOT according to where you think you’ll likely match!

2. Only rank programs you interviewed at!
While there’s no harm in ranking It’s not likely that a program that you didn’t interview at will rank you. So, it only makes sense to rank programs that you actually interviewed at!

3. Ranking less programs does NOT give you a higher chance of matching at your remaining programs!
By ranking less programs, you run the risk of not matching. I highly recommend ranking ALL the programs that you interviewed at, including all the “back-up” programs you interviewed at. If you get matched into your last choice, at least that’s better than not matching at all and waiting another year to match again, and the second time matching is usually more difficult than the first. Do not assume you can rely on SOAP to get a match. Most people who participate in SOAP do not get a position.

4. Do not rank programs where you absolutely 100% do not want to go to.
If you would rather endure a year unmatched, risk not matching the following year, and risk not becoming the physician at all than spending residency at a particular program for the next 3-5 years, then do not rank it. It’s important to note that the match is a legally-binding contract, and so wherever you match, you have to go there. There are residency swaps where you can look for another resident who wants to swap programs with you, but these are harder to do. However, like I mentioned above, I recommend ranking ALL the programs you interviewed at, including your back-ups, because it’s too risky to go unmatched for a year.

5. Regard feedback from the program with a grain of salt!
Some programs may write you emails or letters telling you that they enjoyed meeting you or that you will be ranked highly. Take all of this with a grain of salt, and do not assume they are guaranteeing you a match! They are not! No one knows except the computerized Match Algorithm knows how the match will turn out. To some programs, sending follow-up emails is routine and they’ll tell everyone who they interviewed that they were good candidates. To other programs, saying that you “will be ranked highly” may just mean you are among the top half of candidates they interviewed, which could be 50 candidates for a program with 10 spots! Definitely do not cut short your Rank Order List just because you think you are guaranteed a spot.

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