If you are a current medical school student wondering how to create your residency rank order list (ROL), we are here to guide you through this challenging process. The Match algorithm for the United States and Canada works in a similar way, so whether you are creating the ROL through CaRMS or NRMP and ERAS, keep in mind that a match is legally binding, so you must carefully choose which programs you put on your ROL. In this blog, we will outline how the ROL works and provide you with expert strategies to maximize your chances of matching your top choice program.
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What is the Residency Rank Order List?
Your residency rank order list (ROL) is essentially a list of residency programs that you would be happy to become a part of. The list is ranked in order of preference, from your most desired to least desired program.
On their end, residency programs create the same kind of list ranking applicants they have interviewed and now want to train. A match may occur if both parties rank each other.
Keep in mind that your residency rank order list, and the Match, is a binding contract between you and whatever program you end up matching with. You should only rank programs you are interested in attending. Before you create your list, start thinking about what you’re looking for in a residency program.
“You should apply to whichever program you imagine yourself working in for the next 2-6 years (or more). It is important to write down what is important to you and select the programs to apply to based on those criteria.” – Dr. Neel Mistry, MD, Diagnostic Radiology – University of Saskatchewan.
How Does the Match Work in the US vs Canada?
The Match in the US and Canada both use the same algorithm to place applicants in their preferred programs. The algorithm aims to place applicants into their most desired residency so that they get the best possible outcome based on their ROL.
The algorithm moves from top to bottom of each applicant’s ROL until they find a match with a program that ranked them as well. On the other hand, the programs’ ROLs are reviewed from bottom to top. The algorithm looks for the most desired applicants who wish to be matched to the program.
There are 2 possible outcomes at the end of the Match. One is that you will be matched to one of your desired programs based on your ROL, or the algorithm will not find any matches between you and your program selections. The latter outcome means that you have not been matched. If this is the case, consider researching how to improve your residency application after going unmatched and working on your interview skills for the next application cycle.
How Many Residency Programs Can You Rank?
In the NRMP Match, you can add up to 20 unique programs to your Primary ROL and 20 programs to your Supplemental ROL. If you go over this limit, you will need to pay $30 for each additional program you add. You can add up to 300 residency programs.
However, you should focus on figuring out how many residency programs to apply to so you have the best chance of matching your top choices. This requires some careful decision-making based on your own personal ranking criteria.
“I really struggled with ranking my top 2 programs. I made a number of pro/con lists and ultimately one program I felt I jived with slightly more than the other. After ranking your top 2-3 there tends to be a lot of similarities. I would rank the rest again just based on where I want to live criteria. I know others who ranked based on prestige or fellowship opportunities. But the most important ranks are your top 3 as these are where you have the highest percentage of matching.” – Dr. Monica Taneja, MD, Harvard South Shore, Psychiatry.
To have a solid chance to match via CaRMS for the Canadian Match, we recommend ranking at least 10 programs where you interviewed. You may have more programs that you want to rank but try not to rank any less than 10.
The calculations are less clear for the NRMP match. Just like for CaRMS, how many programs you can and should rank will depend on how many programs you applied to and interviewed at. Firstly, to determine how many programs you need to apply to in your specialty to have a good chance of matching, use the AAMC’s Apply Smart tool. There, you can enter your USMLE scores and your chosen specialty and see how many programs you must apply to to have a certain percentage of matching.
For example, according to this tool, an applicant to diagnostic radiology with USMLE Step 1 score of >245 has about a 70% chance of matching if they apply to 15 programs, while an applicant to the same specialty with a score of <230 will need to apply to 37 programs to have the same chance of matching. When using this tool, make sure to apply to enough programs to have a 90% chance of matching your chosen specialty.
When it comes to creating your NRMP rank order list, try to include at least 12 programs and rank them based on your preferences.
Keep in mind that if you are an international medical graduate, you may need to apply to twice as many programs as non-IMG applicants to have the same chance of interviewing and matching. However, you will still be limited to the same number of entries on your ROL.
Here’s what you need to know about the most competitive residencies:
Residency Rank Order List Timeline
Top Strategies for Creating Your Residency Rank Order List
Now, let’s go over some of the expert strategies you can implement to create your residency rank order list.
Strategy #1: Keep Notes and Start Brainstorming Early
As you visit programs and meet directors and faculty, keep a list of notes about each visit. You might go to over a dozen interviews, so keep a journal to have a clear memory of each interview. This information will become useful as you start to plan your ROL.
Take note of the people you meet, especially those who you will be working with closely, as well as anything else that may affect your decision.
As your interviews wind down, start reviewing your notes and considering which programs can end up on your final ROL. By the time your interviews are completely over, narrow down your list to the programs you liked and want to attend. In your notes, cross out any of the programs you did not enjoy and cannot imagine being a part of.
“My strategy was simple – I ranked all programs based on proximity to home (location) first and foremost … For me, having a good support system was paramount to remain in the right mental space for the next 5 years … The next was quality of resident training (i.e., weekly rounds, resident teaching, exposure to a breadth of cases, fellowship potential) and wellness culture (time off for residents, planned activities, measures to prevent burnout, etc.)” – Dr. Neel Mistry, MD.
Strategy #2: Be Pragmatic
You must be realistic about your competitiveness as an applicant, so make sure to research how you compare with other successful applicants for your chosen specialties and programs.
Whether you are an MD or DO, you can check out the latest NRMP Charting Outcomes in the Match data. For example, you already know how many work experiences related to your chosen specialty you have, so compare them to the mean number of work experiences matched applicants had in the last Match cycle. You can even see a summary of all the important statistics for each specialty, so you can see where you stand!
“[How many programs you rank] really depends on your specialty and your competitiveness as an applicant. If you are a strong applicant applying to a less competitive specialty you can apply to fewer programs; likely 30-40. As your specialty gets more competitive the number of programs you apply to should steadily increase. For hyper-competitive programs such as ophthalmology, I heard of applicants applying to all available programs.” – Dr. Monica Taneja, MD.
This will help you assess whether you are a competitive applicant and help you create a list of programs where you are very competitive and less competitive. In your ROL, make sure to include a variety of more competitive and less competitive programs. And ALWAYS include a program you liked that you know you have a very, very high chance of matching. You can choose how high you want to rank it, but make sure to include one.
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Use our Residency Match Calculator to determine your match chances in your chosen specialty and programs!
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Strategy #3: Be Honest with Your Preferences
The Match system is quite applicant-friendly. It is designed to place you in your most desired programs. This means that you should not rank programs based on where YOU think you have the highest chance of matching, but based on where you TRULY want to attend.
“For me, the most important factor in choosing a program was location. I wanted to be in a city as I felt this would give me the most diverse patient population as well as quality of life. I also was interested in a program that had a VA component as I really enjoyed working with this patient population and envision myself working at the VA long-term … I picked based on the city I wanted to live in and then based on where I connected most with the residents and leadership who I interviewed with.” – Dr. Monica Taneja, MD.
Strategy #4: Do Not Rank Program You Think You Can Match, But Hate
Even though you should evaluate your competitiveness and pragmatically choose some very competitive and some less competitive programs, do not put on your ROL any program that you do not like.
Remember that you have to spend the next 3 to 8 years in this program, depending on the residency lengths of the specialties you chose. If you cannot imagine yourself enjoying your training there, do not put it on your ROL. If you get matched to the program you do not like, there is no going back. The Match is a legally binding agreement.
FAQs
1. What is a residency rank order list?
Each residency applicant creates a list of programs, which they rank from most preferred to least preferred, while programs create the same list of applicants they interviewed. These lists are used in the Match algorithm to find the best matches between candidates and programs.
2. How does the Match algorithm work?
The Match algorithm aims to match applicants to the best option based on their ROL and the ROL of each program they applied to.
3. How many programs should I rank to have a good chance of matching?
In CaRMS, we suggest ranking at least 10 programs. In NRMP, we suggest ranking around 12 programs. However, this number can go up if you are applying to very competitive specialties and programs.
4. When is the ROL deadline?
In NRMP, the deadline to submit the ROL is February 28. In CaRMS, the deadline is February 29.
5. Should I rank programs based on where I think I will have the best chances of matching?
You should always rank programs based on your preference, not based on what programs you think will rank you #1.
6. Should I include in my ROL programs I did not really like, but I think I have a high chance of matching?
This is inadvisable because if you change your mind later and decide that this program is insufferable you will not be able to back out, as the Match is a legally binding agreement.
7. I was told I am a program’s #1 choice. Should I rank them #1 as well even though I have a program I liked better?
Do not rely on this information. It is completely possible that the faculty will meet someone else they like better after their interview with you.
8. Can I rank programs where I did not interview?
This is possible, but highly inadvisable. You have no chance of matching these programs.
9. Can I change my ROL after I certify it?
You can change your ROL after you certify it only if it’s before the deadline.
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