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.

Links for Residency Interview and Match

10 comments to Tips on Ranking Residency Programs

  • Chander Sethi

    Hello Benji,

    Congrats on building an impressive website. More importantly, you are doing a great job by explaining in detail the facts about Caribbean Med Schools . I just attended a sort of a small seminar organized by Aureus University ( Aruba) in Vancouver BC trying to promote their 4 & 5 year MD programmes. I was interested for my 16 year old son who would graduate from his high school next year. But, I was not impressed with the presentation and hence I looked up for more information and hence I chanced upon your website. Thank you for providing a very meaningful and valuable information. I now know the criteria for a creditable & quality med school in the Caribbean. Much appreciated.

    Chander Sethi

    • Benji

      Hi Chander,
      Thanks for reading my blog and I’m glad that you found the information that you needed. I just wish everyone would be well-informed from a neutral point-of-view before making such a life-changing decision as going to medical school. I wish your son the best of luck!
      Benji

  • Mai

    Hi Benji,

    Thank you for posting about your experiences. Your blog is really informative and entertaining to read. I’m thinking about applying to Caribbean med schools, however, what’s holding me back is the fear that I may not be able to secure a residency once I am done with med school (especially now that new med schools are popping up in the US). I want to go into Family Medicine, which I believe, is less competitive. Do you have an idea of what percentage of AUC grads don’t match and what mistakes hurt your chances of matching? Thanks!

    Mai

    • Benji

      Hi Mai,
      Not matching is definitely a big concern among Caribbean medical students, as match rates are much lower for IMGs compared with US grads. Last year, 82.3% of AUC graduates matched into residency. 17.7% did not match. About half of those who reapply for the match the following year get a match. Many people go year after year without matching, ending up with lots of accumulated debt and an unused MD degree. This is true for AUC as well as all the other Big 4 schools. I would imagine the match rates to be even lower in the non-Big-4 Caribbean schools.

      Specialties like Internal Medicine, Family Medicine, Pediatrics, Physical Medicine and Rehability (PM&R), and Psychiatry tend to be less competitive.

      The absolute biggest mistake that hurts your chances is failing the USMLE step exam, or having a low score. This is especially true being a Caribbean medical graduate. You should work even harder to get a better score to be competitive if you are coming from the Caribbean.

      Benji

  • solaris

    Hi Benji,

    I’m planning on applying to AUC next year but i’ve been told that there is a strong correlation between MCAT scores and Step 1 scores. My MCAT is low so I was wondering if it really does mean that I won’t do so well on Step 1. Also, how difficult is step 1 compared to the MCAT?

    Thanks for your help!

    • Benji

      Hi Solaris,
      If you are looking at med schools overall, there is a correlation between MCAT and Step 1 scores. However, at AUC, it’s the GPA during your five semesters on the island that correlates to Step 1 performance. There are people who come to AUC with a lowly score of 21 who ace the Step 1 with a 240+. There are also people who come in with 30+ MCAT who fail the USMLE Step 1. If you make a change, and work hard, you’ll do well on the Step 1.

      In my opinion, Step 1 was much harder than the MCAT. It is an 8 hour exam (seven 1-hour sections + 1 hour break) with tertiary-level style questions. Step 2 CK is 9 hours, and Step 3 is a 2-day exam.

      Benji

      Benji

  • Julian

    Hi Benji,

    Great website! I have a question in regard to elective rotations selection: assuming 30 weeks of elective rotations would you recommend that each elective is 2 or 4 weeks long? If it’s the former it will allow one to audition at 15 different programs, if it’s the latter it translates to 7-8 programs.

    So if we are to only rank programs we interviewed at, what is the rationale for ranking at least 100 programs? I understand that it’s a numbers game, but it seems to me that the only reason to do so is merely to fill a warm body in a spot when it’s impossible to have meaningful contact with 100+ programs.

    Any insight you may shed on this would be great.

    Thanks

    • Benji

      Hi Julian
      Electives have set number of weeks, usually 4-6 wks. I don’t think you can make a good impression of anyone in a timeframe of just 2 wks. All of my letter of recommendations come from attendings I’ve worked with for at least 3-4 wks. Attendings often did not feel comfortable writing a letter just from working with you for 1-2 wks. Nevertheless, the purpose of electives is not to “audition” for a program. It is first and foremost to learn. You can’t learn much of a specialty (like dermatology, or gastroenterology) in just 2 wks. You’ll need at least a month or 6 wks to just get your toes wet.

      Rotating at a certain hospital does not necessarily mean you’ll score an interview there when it comes to residency applications. I applied for residency to most places I did clinical rotations at… and did not receive a single interview from any of those places, despite honoring all my rotations, and getting good evals.

      It makes sense to only rank the programs you interviewed at. You cannot RANK 100 programs, because the max number of programs you are allowed to RANK is 20. However, you can APPLY to 100 programs, or however many your heart desires.

  • Fatima

    I’ve a question that can Asian IMG get residency after getting fairly good marks in steps? or it still remains a vague chance. Thanks

    • Benji

      Yes, having excellent scores, great recommendations, and good people skills will make you a more desirable candidate, which increases your chance for residency.

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