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Should I rank the University or the community hospital residency program higher on my Rank Order List (ROL)?

This is a common question asked by candidates as they put their ROLs this month of February every year.

The idea is that students often think that they should put the program that is likely to have ranked them higher and not the program that they wish to be in the most. Their fear is justified by the thought that if they put the lower end programs at the bottom of the list and they don't match with higher end programs that they have put at the top of the list then there's a risk that they don't match at all.

Here is an example of what am talking about.

Your were interviewed at two programs.

  • Program A is a University hospital with lots of potential and the interviewers did not hint you that they will rank you.
  • Program B which is a community based hospital and no much potential in it but the interviewers liked you and hinted you that they'll rank you.
Of course you like Program X more and you wish to be matched in it. But you have a feeling that they will not rank you and Program Y will likely rank you.

As I said above, Candidates tend to think that putting Program Y as number one in the ROL and Program X as number two in the ROL will increase their chances of getting matched and minimizes risk.

This is wrong. Your ROL should be like this
1- Program X
2- Program Y

And let me explain why.

The NRMP software is designed in a way so that the priority is for the applicants and not for the programs. So on the day of the match the giant machine will come and check each and every applicant and see what he/she has ranked. In our example you ranked Program X. Then it goes and check the program X. If program X has ranked you you are matched and if not it will go and check Program Y (which is now has become your number one rank) and see if it has ranked you or not.

If you have done the reverse by ranking Program X as second you may miss the chance of matching in it if you match program Y beforehand.

How does the NRMP Software work when a match occurs?

It goes little bit more complicated when you a match happens.

Programs are asked to rank three times their quota. For example if they are assigned 10 residents then they should at least rank 30 applicants.

If the program has ranked you within the margin of their quota (for example they ranked you number 9 and their quota is 10 positions) then it's a final match. But if the program did rank you but below their quota (for example they ranked you at position 16) then the match is called a tentative match.

This tentative match will stay there until the giant software continue matching all the thousands of applicants and will see if there are 10 matched applicants before you or not. If 10 applicants matched before you then your tentative match is dropped. If there is no 10 applicants before you (because they have matched in other programs that they ranked higher) then your final match is secured and you will go to that program.
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