• Rajani Katta MD and Samir Desai MD

How to Make a Rank Order List for the Residency Match

Updated: Feb 7


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.


Then, before the deadline, you must certify your list. Otherwise, the NRMP won't receive it.


Does it matter when you certify your rank order list? Just don’t wait until the last minute


You are free to modify your list as often as necessary. However, several days before the posted deadline, you must certify your list.


  • The NRMP will not act on your list until you certify it.

  • Following certification, the NRMP will send you an email confirming the change in your status from “Ranking” to “Certified.”



Remember: Once you certify your rank list, you cannot make any further changes


Although you can make changes to your rank order list as often as you wish, once you certify that list you are now done. A certified list cannot be changed.



When is the rank order list deadline 2022?

For the 2022 Match, the rank order list certification deadline for both applicants and programs is March 2, 2022.



When do programs submit their rank order list?


Each program has their own procedures for submitting rank order lists. Some may submit on earlier dates, and some closer to the deadline.


However, the rank order list certification deadline for all programs in the 2022 Match is March 2, 2022.



Is there an advantage in submitting the rank order list early?


Ranking opens on February 1, 2022 for the 2022 Match. Since the computer algorithm determines the match process, there is no advantage to submitting your rank order list early.



Be cautious about questionable practices


Although the first match was run in 1952, it did not become known as the National Resident Matching Program (NRMP) until 1978. The system was designed to allow programs and applicants to confidentially rank one another and make selection decisions without pressure.


Despite this system, every year some programs and applicants will try to influence selection decisions in their favor. While the NRMP expects that all match participants will conduct themselves in an above-board and ethical manner, in reality this may be compromised.


Programs may engage in questionable ethical practices, and this may be more common than one would think. Misunderstandings are also common. These practices include the following:


  • Making informal commitments


In a survey of fourth-year students at three schools, 43% felt that they had received informal commitments from at least one program. A similar result was found in a survey of urology residency applicants. In this study, 40% of applicants felt that they had received informal commitments.


  • Dishonesty with applicants


A survey of urology residency applicants found that over 50% of the informal commitments failed to result in an actual match. In this same survey, only about half of the PDs felt uncomfortable being dishonest with applicants. Read that again! In other words, about half of PDs in this survey admitted that they would be comfortable being dishonest with applicants.


Another study surveyed family medicine PDs and learned that 94% felt pressured to be dishonest with applicants in an attempt to recruit coveted applicants.


  • Asking applicants how they planned to rank the program


In their Statement on Professionalism, the NRMP states that “although the Match Participation Agreement does not prohibit either an applicant or a program from volunteering how one plans to rank the other, it is a violation of the Match Participation Agreement to request such information.”



Do not naively believe assurances from program directors


After interviewing at a program, you may receive a follow-up email, letter or telephone call from the PD stating that the program plans on ranking you at the top of their list. You may be thrilled to hear such great news. But beware. Such a statement made by a program in no way serves as a guarantee that they will rank you highly. You cannot allow comments such as these to affect the order of your rank list.


At the NRMP website, it is clearly stated that applicants should not rely on statements made by programs when creating their rank order lists. As thrilling as it may be to hear “Our program plans to rank you high on our list,” this isn’t binding in any way. We know of multiple cases in which students have been given such assurances, only to subsequently not match at those programs.



Know what constitutes a match violation


Applicants often seek an understanding of the Match policy, including what might constitute a violation, from their peers. This practice often leads to misinformation. In one study, nearly half of students perceived a violation that did not meet NRMP definition for a violation.


To gain a solid understanding of the Match policy, attend all orientation and information sessions about the process at your school. Read the rules of the Match, which are often given to students by their schools and are also available at the NRMP website.



Recognize if you’re at risk for an unsuccessful match, and take steps to prepare for SOAP


After you’ve finished ranking programs, there’s one more question to ask yourself. Are you at risk for not matching? According to the AAMC, there are seven major reasons why U.S. allopathic seniors may fail to match:


  • Low USMLE or COMLEX scores

  • USMLE or COMLEX exam failure

  • Not competitive for chosen specialty

  • Lack of backup specialty plan

  • Failure to follow recommendations of Dean’s office or faculty

  • Advisor

  • Poor interviewing or interpersonal skills

  • Ranking too few programs


If you believe that you’re at risk for an unsuccessful match, we urge you to become familiar with the Match Week Supplemental Offer and Acceptance Program (SOAP). SOAP was established by the NRMP and serves as the process through which unmatched applicants apply for positions in unfilled residency programs.


To maximize your chances of success during SOAP, there are a number of measures that can be taken. They do, however, require time. For more about preparing for the SOAP, please see this post.


 

Dr. Rajani Katta is the creator of The Residency Interview 101, the online course that helps applicants quickly and confidently prepare for their residency interviews. She is also the co-author of The Successful Match: Rules to Succeed in the Residency Match and served as Professor of Dermatology at the Baylor College of Medicine for over 17 years.



Dr. Samir Desai is the author of 20 books, including The Successful Match and The Clinician's Guide to Laboratory Medicine. He has been a faculty member in the Department of Internal Medicine at the Baylor College of Medicine for over 20 years and has won numerous teaching award


If you'd like to receive a free 100+ page excerpt of The Successful Match, please sign up here.



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