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Check Yourself Before You Wreck Yourself: How to Create a Match Rank Order List

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As you look toward the NRMP Match rank order list open date on February 3, you’ll want to avoid simple missteps. Improving written materials and interview skills are critical, but all of that work can go to waste if applicants do not understand basic strategies for the Match. Way back in November 2015, the NRMP published an article called, “Understanding the interview and ranking behaviors of unmatched international medical students and graduates in the 2013 Main Residency Match” in the Journal of Graduate Medical Education. The data is still relevant today.

Sadly, the authors found that some applicants made strategic errors including the below:

1. Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.
2. Not attending all interviews, thus failing to capitalize on every opportunity to market themselves. (I suspect this error is less common now with the advent of virtual interviews.)
3. Misunderstanding the Match and, thus, ranking programs at which applicants did not interview.
4. Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is a video explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

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Introducing NRMP’s Rank Order List Lock Pilot

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In October I wrote a blog entry about the benefits of virtual interviews. One issue that has come up is the concern that those who choose to do in-person interviews may have an advantage compared to candidates who interview virtually. The NRMP has noted this worry and is, consequently, instituting a voluntary Program Rank Order List Lock pilot for internal medicine, pediatrics, and vascular surgery for the 2026 Main Residency Match cycle.

The idea is that programs can choose to finalize their certified Rank Order Lists and then provide time for interviewed applicants to come in-person, thus reassuring candidates that visiting or not visiting will not affect their candidacies.

Here is a statement from NRMP regarding the voluntary pilot. It’s an interesting idea, and I’m curious to see how it will play out.

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Your Residency Application: Five Factors to Prioritize When Creating your Rank List

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Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want – first goes first, second goes second, etc.

2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.

3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.

4. Consider whether you could spend your whole life at the institution or in that program’s location. It’s a lot to grapple with, but many residents graduate and stay for the rest of their careers.

5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

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Residency Applicants, Thinking about How to Create your Rank Order List? Check out this Easy Advice.

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For those of you who are starting to craft your Match rank order list, please make sure you follow this simple strategy: Rank your first choice first, your second second, your third third, etc.

In other words, your most successful approach is to create your list in order of your real preferences. Although the Match algorithm is mathematically quite complicated, because the process always begins with an attempt to match an applicant to the program most preferred on the applicant’s list, you do not want to try to “game” the system. For example, I’ve had applicants tell me that they plan to rank a less preferred institution higher because that program has more residency slots. That’s a no-no. The applicant will actually be harming him/herself with that strategy.

Two weeks ago I posted a short NRMP video that explains the Match algorithm. Here it is again. Here’s also a less-than-one-minute Guru on the Go© video “NRMP Ranking to Avoid a Spanking” to emphasize your optimal strategy.

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NRMP Match

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Congrats to all those who successfully matched the week before last! The NRMP just published statistics from this year’s Main Match:

Of interest, there were 42,549 applicants who submitted certified rank order lists in this year’s Main Match, and 34,075 of those matched to PGY-1 positions (80.1%). This was a 1.6% increase over last year.

The NRMP also reports that out of 39,205 total positions offered, 36,943 filled (94.2%), and of 36,277 first-year positions offered, 34,075 (93.9%) filled. These rates were similar to last year’s. Of 6,087 total certified programs, 5,367 filled (88.2%), which was a decrease from last year, per the NRMP.

For more numbers, take a look at this NRMP press release.  

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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