Rank Order Lists Need to be Longer for a Successful Match

It is February and it is time for you to make your rank order list (ROL) for the Residency Match. There have been some critical trends in the past few years that students should be aware of to make wise decisions about their ROL.

  1. The residency match is more competitive than in previous years as the number of graduating students has increased, but the number of residency training positions has leveled off. (The Balanced Budget Act of 1997 capped the number of new Medicare-paid residents that each teaching hospital can claim, resulting in a system that cannot keep up with need.)
  2. There are very few positions left to match into during ‘the scramble’ or ‘SOAP’ process with thousands of applicants attempting to secure those positions. In the past 3 matches, almost every specialty has filled prior to ‘scramble’. While applicants may find a residency, it will most likely not be in the specialty of choice. Students had the most success finding positions in preliminary surgery programs, family medicine, and psychiatry in the past few post match ‘scramble’ process.

Because of these two important factors, (in general) an applicant’s ROL needs to be longer than in past years to successfully match. Today, even top students shouldn't assume they will automatically match by attending 10 interviews and ranking only their top 6 programs. If you are talking to senior residents, their experiences may be different than yours will be – as times have changed since they started their training.

Hopefully, you have been wise and have interviewed at enough programs for your specialty. The more competitive the specialty, the more interviews needed to match.

During a student panel in front of an MS 3 audience, a urology applicant announced that he had applied to over 80 programs. A chatter broke over the room, for surely everyone was thinking, "this guy is crazy."  What they did not realize, as students who had not started the application process, was that this was a calculated plan suggested to all of our urology applicants. The applicant on the student panel was one of only two students that matched in urology that year. Unfortunately, the applicants that did not use a similar plan went unmatched. Based upon the market, the competitiveness of the specialty, and the fact that the initial application was an investment in his future, he eagerly accepted what he needed to do to match. He applied to and interviewed at as many programs as he could, matched, and went on to a successful career. His rank order list had well over the recommended number of urology programs, as well as preliminary programs. There were no urology ‘scramble’ positions that year.

Now, you may not need to apply to 80 programs, but for some competitive specialties, you will.  It also follows that the less competitive a student’s academic profile for a specialty, the more applications are needed to secure the number of interviews needed for a successful match. This is also true for any preliminary or transitional program positions that are required for your specialty, as they have become extremely competitive (especially the internal medicine prelims and transitional program positions).

As you can see from the NRMP data below, the applicant and program ROL has become longer over the years. These data indicate the averages across all applications and not by specialty. However, one can see that if an applicant’s rank order list is less than 10 for most specialties, they are at great risk for not matching. In today’s job market, these results may impact applicant’s decisions about whether to rank a program that they are hesitant about. Would you rather have a job that you aren’t thrilled with (located somewhere in the tundra with no place to shop), or would you rather not have a job?

 When looking at the data, there does not seem to be a significant jump reflecting the shortage of positions declared above. However, what this data does not address is the number of students matching into specialties that were not their choice of career in order to continue their training and not go unmatched.  

US Seniors Data

Year Matched Applicants Unmatched Applicants
  Number Matched Average
Length of ROLs
Length of ROLs
2001 12,813 (95.0%) 7.88 676 (5.0%) 4.71
2002 12,281 (95.6%) 7.96 587 (4.4%) 4.62
2003 12,692 (94.7%) 7.97 710 (5.3%) 5.02
2004 12,731 (93.8%) 7.99 843 (6.2%) 5.34
2005 12,975 (94.7%) 8.25 726 (5.3%) 5.29
2006 13,285 (94.7%) 8.40 748 (5.3%) 5.26
2007 13,486 (94.7%) 8.90 756 (5.3%) 5.62
2008 13,406 (95.0%) 9.26 699 (5.0%) 5.63
2009 13,560 (94.0%) 9.59 858 (6.0%) 6.27
2010 13,920 (94.0%) 10.17 896 (6.0%) 6.83

(* The data are based only on applicants' primary rank order lists and do not include couples.)

As this data indicates, U.S. seniors consistently have the highest match rate and the longest average ROLs.

Below is a general applicant table for residency applicants that would include anyone that is not a U.S. citizen or senior medical student. This could be an applicant that is reapplying after not matching in her/his original choice, making a career change, or coming from another country to train in the U.S. These matched applicants are not as successful and these numbers suggest that they should increase their ROL list for greater success.

General Applicant Data

Year Matched Applicants Unmatched Applicants
  Number Matched Average Length of ROLs Number Unmatched Average Length of ROLs
2001 17,849 (78.1%) 7.40 5,009 (21.9%) 4.71
2002 17,986 (80.4%) 7.46 4.387 (19.6%) 4.14
2003 18,382 (80.5%) 7.45 4,443 (19.5%) 4.46
2004 18,808 (78.5%) 7.44 5,156 (21.5%) 4.40
2005 19,234 (79.7%) 7.65 4,901 (20.3%) 4.48
2006 19,484 (76.4%) 7.81 6,011 (23.6%) 4.51
2007 20,042 (75.1%) 8.23 6,660 (24.9%) 4.64
2008 20,167 (74.0%) 8.52 7,094 (26.0%) 4.32
2009 20,458 (72.3%) 8.74 7,854 (27.7%) 4.46
2010 20,797 (71.9%) 9.25 8,130 (28.1%) 4.50

(* The data are based only on applicants' primary rank order lists and do not include couples.)

The NRMP also collects and tabulates data on the average number of applicants are ranked for each residency position before a successful match is achieved. This is depicted in the chart below and again, one can see that there has been a steady increase over the years, but a fairly large jump in the past 2 years on the number of ranks needed to match with an applicant. So while students need to go on more interviews and rank more programs on their match lists, residency programs are following suit and increasing their length of their ROLs as well.

Program Data*

Year Filled Programs Unfilled Programs
  Number and % Filled Average Length of ROL Average Ranks per Position Number and % Unfilled Average Length of ROL Average Ranks per Position
2001 2,688 (72.2%) 54.76 9.28 1,036 (27.8%) 25.67 4.75
2002 2,747 (74.3%) 54.75 9.24 950 (25.7%) 26.94 5.03
2003 2,748 (74.5%) 55.04 9.32 942 (25.5%) 30.24 4.89
2004 2,936 (78.7%) 55.61 9.40 796 (21.3%) 27.93 4.85
2005 3,005 (79.4%) 55.66 9.35 779 (20.6%) 26.63 4.90
2006 3,159 (81.8%) 55.85 9.74 702 (18.2%) 25.31 4.65
2007 3,360 (84.1%) 56.80 9.96 635 (15.9%) 25.23 4.97
2008 3,410 (84.4%) 57.66 10.04 628 (15.6%) 29.50 5.37
2009 3,601 (87.3%) 58.94 10.52 526 (12.7%) 27.56 5.68
2010 3,614 (87.3%) 61.78 11.11 528 (12.7%) 27.68 5.64

(* Tables from the NRMP: Data on programs are based on the number of positions offered. Any programs with one or more positions unfilled after the match, regardless of the number of positions filled, is included in the unfilled program data.)

Only you can decide whether to include all the programs where you have interviewed on your ROL. To make that final decision, know ahead of time that if you rank a program and match, it is a binding agreement for one year. At the end of the first year, the program and the intern/resident will then decide (or not) whether to continue the training agreement. If you dislike a program after visiting, you must make the decision whether to include it in your ranking list. This is where the decisions become really difficult. If you rank a program, but do not like the program, you have a binding contract that says you must go there. However, if you do not rank it at the bottom of your list, you risk not having a job at all and finding a job outside of the match in your choice of specialty will be difficult. This is a hard decision, so we hope that every program you visit meets at least your minimal criteria and isn’t located on a desolate arctic plain hundreds of miles from good shopping or entertainment.

To read an article about the new SOAP procedures that will take the place of the Scramble: http://www.doctorsintraining.com/blog/soaping-up-the-scramble-beginning-2012/

To read an article about the projected physician shortage and how it may affect you as a physician go this article in the AAFP: http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/201020aamcwrkfrcupdt.html



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