• Rajani Katta MD and Samir Desai MD

How to Make a Rank Order List for the Residency Match

Updated: 7 days ago

After the intense preparation and stress of residency interviews, you're finally able to make your decisions on how to rank the residency programs at which you interviewed.

Welcome to the rank order list.

In this post, we're going to discuss the rank order list:

  • What is an NRMP rank order list?

  • How do I create my rank list?

  • How do I certify the rank order list?

  • What are important mistakes to avoid when creating and submitting a rank list?

Creating your NRMP rank order list:

important tips and advice

The last step in the residency application process is the creation and certification of your rank order list (also known as the rank list or ROL). On the official rank list, you list the programs, in order of preference, which you would be willing to attend.

Programs also submit their own rank lists, in the order in which they would extend offers.

The residency match takes into account your rank list and the residency programs' rank lists

Sometime in February or March, the Match takes place. A computer matches each applicant to the highest ranked program on the applicant’s list which has offered them a position. The results are then announced throughout the country in mid-March on “Match Day.”

For many, Match Day is the happy culmination of a very long, hard application process. Unfortunately, other applicants experience bitter disappointment.

There are a whole host of reasons as to why match results may not be favorable. However, we’ve seen some students who do everything right, only to make critical errors when it comes time to create and submit their rank list. Errors at this final step in the process can undo all of your previous efforts.

Image of faculty member reviewing an NRMP rank order list
It's important to create, submit, and certify your NRMP rank order list based on your own criteria and according to the correct procedure

Always rank according to your own criteria

After the interview season ends, the process of finalizing your rank list begins in earnest.

The National Resident Matching Program NRMP rank list is a list of the residency programs at which you interviewed and at which you would be willing to train, placed in your order of preference. This involves sorting through a great deal of data.

Some students are tempted to rank based on reputation alone. “I’d like to attend the most prestigious program I can get into.”

Unfortunately, ranking programs is rarely that simple. You’ll be spending a minimum of three years of your life at this program, and you need to take into account a whole host of other factors.

A useful checklist for evaluating residency programs can be found in Strolling Through the Match, a publication produced by the American Academy of Family Physicians. It’s accessible free to applicants at www.aafp.org.

Consider also the following questions:

  • Will the residency program provide me with strong clinical training?

  • Will that training be broad-based, with exposure to all facets of the field?

  • Will it provide some subspecialty training in my areas of interest?

  • Will it provide training in additional areas important to me, such as

  • research training?

  • How did I feel when I visited the program?

  • Would I be able to work with the people there?

  • Could I live and work in this city for the next several years?

  • What are the strengths and weaknesses of the program relative to others?

  • Does the program offer an environment that will allow me to reach my full potential?

Should I rank programs based on where I think I might be accepted, or where I really want to go?

You stand the best chance of matching into the residency program that you want if you rank it as your top choice. That's the whole point of the computer algorithm at the heart of the NRMP.

Do not create your rank list based upon where you think you will be accepted.

Never rank a program that you wouldn’t want to attend

If you have serious doubts about a program, do not put that program on your rank list. If you place it on the rank list and you match, you are officially committing to train at that program.

In fact, in registering for the Match, the NRMP has applicants electronically sign the Match Participation Agreement. This agreement states that a “match between an applicant and a program creates a binding commitment to accept or offer a position. A decision not to honor that commitment is a breach of the Agreement and will be investigated by the NRMP.”

While applicants can be granted a waiver from their Match commitment, only the NRMP can grant this waiver. Programs are not allowed to grant waivers and must report all waiver requests to the NRMP.

If the NRMP denies the waiver request, you will be expected to honor your commitment to the program. Failure to accept the position is considered a violation and may lead the NRMP to prohibit you from acceptance into another NRMP-participating program for a period of time following the decision.

In other words, if you match to a program and then decide that you don't want to train at that program, the program does not have the ability to release you from your commitment. Only the NRMP has that ability. And if they decline that request, and you choose not to start training at that program, you may be prohibited from trying to match into another program.

It doesn't matter if your spouse is in a different city, or if you will have to be away from your child. (All situations that we've seen occur in the past.) The NRMP will evaluate each potential grant waiver on a case by case basis.

While the NRMP has approved some waiver requests, others have been denied.

What's our recommendation? Overall, it would be better to not match at all than to match at a program that you have no desire to attend. In the event that you don’t match, you still have additional opportunities to strengthen your application and apply again.

Rank every single program that you would consider attending

You should place every program you would consider attending on your rank list. Submitting a longer list will not affect your chances of matching with those programs that are higher on your rank list. This is clearly explained in the information the NRMP provides to applicants regarding the Match.

Some students, for various and often misguided reasons, do not wish to rank every program that they would consider attending. Before you leave any programs off your list, factor in:

  • Competitiveness of the specialty

  • Your qualifications

  • Competition for the specific programs being ranked

We have encountered students who create too short of a rank list because they feel confident of matching into one of their top choices. These students are devastated when they don’t match at all. Don’t let overconfidence ruin your chances.

Image of residency applicant holding their rank list and paperwork
Rank every single program that you'd want to attend.

How to make a rank order list for the residency match

Making a rank order list involves two important steps:

  • Creating your list

  • Certifying your list

Once you create your rank order list in the system, you are allowed to modify your list as often as necessary until the posted deadline, which is typically in late February or early March.