How to Create Your Residency Rank Order List

What is the Residency Rank Order List?

Your 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 (yet, you must only include programs you would want to attend).

On their end, programs create the same kind of lists ranking applicants they have interviewed and now want to train. A match may occur if both parties rank each other.

How Does the Match Work in the US vs Canada?

The Match in the US and Canada uses 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.

NRMP ROL Nuances

In the NRMP Match, there are 2 types of ROLs:

1. The Primary list is used to rank Categorical, Preliminary, or Advanced programs.
2. If you rank an Advanced position in your Primary list, you will have to create a Supplemental list. This ROL will have only Preliminary positions, which you will complete in 1 year (general training) and then move on to your Advanced program.

What does this mean? This two-tier system is designed for applicants who want to pursue certain specialties that require advanced training. If you rank an Advanced program on your Primary list, the Supplemental list will let you rank preliminary programs in a way that would connect your preliminary and advanced program choices. This means that even though your residency training will be technically composed of two parts, you will secure it as one in the NRMP application.

For example, if you choose a medical specialty like neurology, you will create a Primary ROL listing the Advanced programs you want to attend, and then you will create a Supplemental ROL where you will list preliminary training programs that will help you get general training before your narrower training in neurology begins.

Note that only applicants who list Advanced programs in their Primary ROL must create a Supplemental ROL.

Curious how much residents make? Check out this infographic:

How Many 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 programs.

However, you should focus on figuring out how many programs you should rank to have the best chance of matching your top choices. We will discuss top strategies for this in more detail below, but for now, let's briefly discuss some statistics.

To have a solid chance to match via CaRMS, 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. Of course, the number of programs you can choose from will highly depend on how many residency programs you applied to and how many you interviewed at. This is why it’s important to apply to a good number of programs at the onset. 

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 in order 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 ranking 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.

ROL 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.

Strategy #2: Be Pragmatic

While it is very important to rank programs based on your actual preference, it does not mean that you cannot be pragmatic when it comes to choosing which programs to include in your ROL. 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!

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. 

TIP: use our Residency Match Calculator to determine your match chances in your chosen specialty and programs!

Strategy #3: Do Not Rank Program You Think You Can Match, But Hate

This is closely related to the previous strategy. 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 did 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.

Strategy #4: Take into Consideration Your Specialty’s Competitiveness

While we do recommend including at least 10 programs on your ROL in CaRMS and 12 in the NRMP, you may want to rank more programs in your list if you are applying to some of the most competitive residencies out there. The more competitive your specialty, the more programs you may want to rank, keeping in mind strategies #2 and #3 we outlined above.

Want to learn more about which residencies are most and least competitive? Take a look at this video:

Strategy #5: Be Honest with Your Preferences

As you could see from our description of the algorithm, the 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.

Additionally, do not feel obligated to rank a program because its faculty or director has openly told you that they will rank you #1. While you should feel proud to have made such a great impression, do not make your decisions based on this. Firstly, because these conversations are informal and not binding. It is possible that after meeting you, they have an interview with another applicant who they now want to rank #1. So do not put too much faith into any discussions of such nature. Only the ROL will be considered for the Match, not somebody’s words during the interview. 

Conclusion: Certify Your ROL on Time

This may seem like a very simple and unnecessary reminder, but do not make the mistake of waiting too long to certify your ROL. As we already mentioned, if you miss the deadline, you will be automatically withdrawn from the Match.

Ranking your preferred programs is a difficult decision but try to settle on an order as soon as you can. You should know that it is possible to change your CaRMS and NRMP ROL rankings after you submit them, but you must recertify any changes. You will not be able to change your ROL after the deadline.

Final reminder: it might not be the best idea to make last-minute changes to your ROL, as these are usually made compulsively, without much thought. This is why keeping good notes, planning in advance, and doing your research are so important in creating your residency rank order list.

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To your success,

Your friends at BeMo

BeMo Academic Consulting

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