MakingList“How do I decide how to order the residency programs on my rank list?”

On Feb 24, 2010, every residency applicant will have a brief moment of panic as their rank list is submitted and officially certified.

Next week, I’ll be joining a group podcast with Dr. Rob Rogers (Maryland) and Dr. Dave Manthey (Wake Forest) for the next installment of EMRAcast. This new podcast series was created by Rob for EMRA for the specific purpose of providing advice to medical students. I still find it fascinating how much you can get done virtually. We’ll all be using Skype from our respective offices and recording our conversation.

I feel sorry for Rob because getting the 3 of us together will probably need a LOT of editing. We end up joking around most of the time.

The podcast theme

Making your rank list – pearls and pitfalls

Off the top of my head, my top 10 list of tips in making a residency rank list is:

  • Don’t try and game the system. The match algorithm is weighted towards the applicant. Rank your first choice as #1. There’s no logical reason to rank a seemingly more competitive program (but that you aren’t as excited about) higher to improve your chances of getting in the program.
  • Go with your gut. Where did you feel that you fit in best? Where would you be happy? Each program and its residents has a unique “personality”. Don’t just select a program for its name or reputation.
  • Do your homework. Make sure you have the facts about each program. Don’t go by the interview trail rumor mill. Don’t base your facts on anonymous forums. I’m constantly shocked by how wrong some rumors are. The best ways to find the truth are from the residents in the program. Just fire an email off to them.
  • Find a program which matches your interests. Some applicants already know that they want to pursue a particular area of EM. This may be EMS, global health, hyperbarics, toxicology, ultrasound, or public health. Be sure there is a faculty member there who can help mentor you in developing your niche. Contact that person to ask about their ability to mentor residents.
  • Factor in a support system. Residency, especially internship year, can make it hard to live a balanced life. Having friends or family (who you like) in the area can be important in having a life outside of residency.
  • Look at the trauma, pediatric, and ICU experiences. Determine how important each of these experiences are for you. For instance, if you want to do a pediatric EM or critical care fellowship, a strong pediatric or ICU experience during residency would be ideal. Although there are required minimums for each of these 3 aspects of training, residencies can vary widely in how much exposure there is.
  • The educational culture. How are the residents taught? In the required weekly residency conferences, are the conferences high quality? Are they taught by the residents or faculty? Are the faculty good bedside teachers? Does the educational curriculum fit your learning style?
  • Long-term geographical consideration. If you already know that you would really like to live in [your perfect city], it helps to do training somewhat nearby. You will be able to more easily network into a job. During residency, I was offered a job where I moonlighted.
  • Don’t shorten your rank list because you got a “we love you” call or note. Be cautious about phone calls or emails from programs who tell you that they were really impressed by you. You have to remember that year to year, a program goes down a different number of ranks on their list before filling all the slots. For example, if a program gives a call to their top 50 applicants and goes down to 70 on their rank list, all 50 applicants have a great shot of matching there. Then next year, however, the program only goes down to 20 on their rank list, after having made their usual top-50 phone calls. You can do the math. Don’t be the one to fall through the cracks.
  • Only list programs that you would be willing to attend. It reflects extremely poorly on you if you were to match at a program and refuse the position. It’s essentially a breach of contract and this unprofessional action will follow you whereever you go (especially if you try to apply again next year). That being said, for first-time applicants from U.S. allopathic medical schools who have passed their USMLE boards on the first attempt, I would list AT LEAST 10 programs to prevent having to enter the Scramble.


Thanks to RxnMan comment below, I uploaded the 2009 NRMP Charting Outcomes for the Match (pdf, EM relevant sections only) in case you wanted to read how you would have stacked up to last year’s match class.

Can you share with me your suggestions? I’d be happy to share the best ones on the podcast (and credit you, if you leave your name in the comments).


Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD