Rank List Run Down

Congratulations on being done with your interviews.  You can take your interview suit to the cleaners, or if you over-interviewed, you may just need to burn it.  You can check your frequent flyer miles to see if you can cover a ticket to somewhere warm.  You may even be able to step back and look objectively at the programs you recently interviewed with.  

Your last major residency application task is now upon you.  You have until February 26th to finalize your Rank List.  And you are likely putting a lot of time, thought, and stress into this decision.  

"How to make your Rank List" was one of the first topics we tackled here, and very little has changed about the whole process.  Our Rank List Tips still hold true, and you ultimately should still Go with your gut, in defiance of what your giant spreadsheet is telling you. 

While there are some differences between this year and last, overall competitiveness has not changed significantly.  The ratio of available spots to total applicants is the same.  Both numbers have been gradually and proportionally increasing for years. This does NOT appear to be what Medical School Dean's have been claiming, as the major change this year is in the number of applications each person has sent out AND in the number of interviews they have done.  I do not blame the Dean's for giving this advice, their job is to ensure that all of their students match.  They will do what they think is necessary to accomplish that goal.

The difference this year is that the "middle class" of applicants has shrunk.  There are fewer applicants with a number of programs to rank (8 - 10) who should feel comfortable about matching.  Instead, there appears to be an unusually large divide between the "haves" (>10 - 12 programs, AKA: the over-interviewers) and the "have nots" (<6 - 8 programs to rank).  This has introduced added uncertainty into an already stressful situation.  Programs fear that they have interviewed the same candidates as EVERYONE else and won't match enough of them.  Applicants with low numbers of interviews fear that they are only padding the back-end of rank lists at programs that interviewed extra or played it safe in offering interviews.  While most of the concern is likely unfounded, given the steady growth in BOTH spots and applicants, we will not know how this plays out until after the match.  

The advice that follows has held true in past years and is likely to still be relevant:   

1. Rank any program that you would consider to be better than scrambling (SOAPing) to a surgical pre-lim. year or to family medicine. There is effectively no scramble within EM.  If you don't match, your next shot at EM is next year.  
2. Rank programs in the order you like them.  The match algorithm favors the students. You will match to the program you rank highest that gets to your spot on its Rank List.  There is no advantage to you in ranking a more "realistic" program ahead of a "reach".  
3. Once you settle on your #1 program, you need to let them know.  Programs want to be liked, just like everyone else.  Just don't tell more than one program they are your #1.  The world of Residency Program Directors is a relatively small one and you don't want to get caught in a lie.

For more on making your rank list see these posts from Academic Life in Emergency Medicine: Making Your Rank List and Top 10 Tips When Making Your Rank List, as well as our post on Going with your gut that includes a more detailed explanation of the Match Algorithm in case you do not believe the whole "student weighted" thing.

Best of luck!  You are almost there.