Congratulations on completing interviews! Now, it’s time for the stressful part to begin. (By now you have probably realized that's how medicine works - as soon as you complete something incredibly difficult someone is like “oh those were the good days.”)
The rank order list is really stressful especially if you don’t understand how the match works. As strongly as I feel against the match system, it does favor the applicant. It’s important for you to really understand this before you make your list. Basically, no one can take your spot from you. There’s no true incentive to rank a program you think you have a “better chance of matching at” higher than a program you love.
"As strongly as I feel against the match system, it does favor the applicant...No one can take your spot from you."
If "program A" ranks you higher than Bob, you will match at "program A" unless you match at a program you ranked higher than "program A" or "program A" fills with applicants that they ranked higher than you (who either ranked "program A" #1 or did not match at programs they ranked higher than "program A"). That sentence is probably a little confusing. I initially starting creating graphics to explain how the algorithm works, but the NRMP has already put so much effort into explaining it (yup, it’s no secret).
Seriously, read all of this. This is the most important decision you will make in your career.
If you end up at a program or in a specialty you don't love, you absolutely can switch, but it is a big deal and a lot of work.
I've listed below my thought process in making my rank list, but this will be so unique to each individual. For me, I wanted to go home to Alabama for intern year to spend time with my family and train at the best dermatology program (for my ultimate goals) I could match into.
Intern year rank list: For dermatology, you can do either an internal medicine preliminary, surgical preliminary, pediatric preliminary, or transitional year. I only applied to internal medicine preliminary and transitional programs. I mentioned in a previous post that I only interviewed at a handful of intern year programs because I didn't think interviewing broadly was worth the time and money (especially since I knew exactly where I wanted to be). Instead, I focused my energies on the three programs I wanted.
My biggest decision points were preliminary vs. transition year program and academic vs. community hospital. Most seasoned dermatologists recommend spending intern year at an academic hospital. I talked with some younger faculty and PGY-2 dermatology residents who had done this, and there didn't seem to be any real advantage in terms of being more or less prepared for the start of dermatology training. One faculty member actually mentioned to me that her coresidents who had done a transition year had more time to read about dermatology during the year and therefore had a very mild (probably insignificant) advantage when starting training. Most dermatology residents don't know any dermatology starting because there is such little exposure to the field in medical school and intern year. None of the residents I talked to that did an academic preliminary year felt that they learned very much medicine during that year (intern year includes a lot of scut and social work, although I'm sure they learned more than they realized) or remembered much general medicine after a year of pounding their brain with rashes.
Academic programs are notorious for being very difficult and I wanted a middle of the ground program. I, of course, wanted to learn as much medicine as possible, but I didn't feel I needed the same level of training as a categorical medicine resident. It was, however, important to me that I learned something. This narrowed my preference to two transition year programs. My home has a transition year at a community hospital that is quite academically rigorous. My hours are long and my attendings are some of the most hard-working and curious people I've ever worked with, but the work load is a little lighter and I have a good number of weekends off. In addition, it's nice to get a realistic view of private practice vs what my academic attendings tell me private practice is like.
That was my rationale behind ranking a community transition year program #1. Oh I forgot to mention the money I'm saving on rent has allowed me to kickstart a real emergency account and replace a lot of things that have become out of date during residency, like my computer and wardrobe.
Other people use intern year to live in a different part of the country for one year (but keep in mind that means you have to move twice in one year and the last day of your intern year program can be as close as the day before the start of your secondary program).
Advanced program (dermatology) rank list: My only priority when making my match list was matching at the best dermatology program for me, which is a luxury I am forever grateful for. You may have the luxury of having a significant other or family to consider. I took a little time to review all of the information packets I was given, but I mostly used the checklist and numerical rating system I mentioned in the preparing for residency interviews post. Of course, your checklist will be different from mine depending on your priorities. While going on interviews I had a pretty good idea of tier levels each program would fall into - top 5, bottom 3, and the middle. I thought it would be pretty easy to then rank them within these tiers, but it was incredibly difficult. Every program is slightly different. I’m a very indecisive person and the rank list very much felt like shutting the door on so many amazing opportunities. Basically, because that’s what you’re doing.
Although the checklist was incredibly useful, I eventually had to add a subjective, weighted component because the items weren't equally important. Clinical exposure, reputation, and exposure to skin of color (SOC) were all very important to me. My #1 and #2 were outstanding, highly regarded programs with tons of SOC exposure, but after that I had to decide between name/reputation vs exposure to SOC (based off of the programs I received interviews at, not of dermatology programs as a whole). I ultimately chose to rank reputation higher than exposure to SOC. It was a hard decision, but I felt that the larger, stronger programs would benefit me more in my dermatology career and because I had such a desire in SOC, i would learn it no matter what.
Once the items of the checklist were subjectively weighted, it allowed me to come up with pairings. I knew what my top 2 schools were, my 3 and 4, and so on, but putting them in order within the pairs came down to feel - which program did my gut like more.
I matched at my #1 transition year and #1 dermatology program. I think this happened because I put so much thought into what was right for me. I'd like to think that the feeling was mutual. #happyending
Good luck to you all! I'm happy to answer questions either in the comments section or the contact page. Let me know where you match in March!!