RANK ORDER LIST- How to get this last step right

The anxiety is killing now. Match day is March 14, 2016 (March 18th to know where you matched). It is just a few short weeks from now but the wait seems forever.

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You have arrived ladies and gentleman. You cleared your USMLE exams, hustled your way into some observerships, got your name on a few stellar publications and smiled your way through interviews in high heels and polished oxfords. Now you reap the benefits of your hard work. You submit the rank order list, sit back and enjoy a glass of fine (but not too expensive) wine.

Like every other step (no pun intended!) you have taken thus far to make your dream of practicing medicine in US come true, this last step of rank order list needs to be well thought out and planned. Look on the internet about how to make your rank order list and every site will say- list the programs you think you will be happy at and do not list other programs. That sounds great, but not for an IMG with limited number of interviews or not so glorious scores.

I get it.  I have been through this myself and I get asked from  students every year before ROL submission. You do not want to spend three years in a malignant program. You are not sure yet if you want to specialize or not . You don’t want to be in a small town in middle of nowhere for your residency. You are worried if you accept J1 visa now, the waiver job will be in Podunk city on highway to ‘who knows where’
I was torn apart when getting my rank order list ready. There are so many things to consider when ranking the programs. University or community, fellowships, locations, weather, visa, family closeness, job options for spouse, gut feeling after the interview, friends who did their residency in the program and so on.

After seeing so many students go through this tough time in their life, I have realized this:

For us IMGs, it boils down to two pivotal things: fellowship and visa

  • FELLOWSHIP- If you are serious or even thinking about doing a fellowship after residency in any branch, you should rank the university program with most number of fellowship spots internally as your number 1. If you did not get an interview from any big universities with in house fellowship, then rank the program affiliated to the nearby university with fellowships. Even if it means J1 visa. Next pick the community programs without in house fellowships. The community programs will advertise how many of their residents have gone on to become cardiologists, gastroenterologist, etc. Good for them but we don’t know if they are IMGs/AMGs, what scores and applications they had. Fellowships are very competitive these days and being in a university with fellowship spots will be your best bet.
  • VISA: If you are not thinking about fellowship and would rather be a hospitalist, primary care or an urgent care doc, then focus your attention on visa. You rank the programs who offer H1 before those that do not offer H1. Plain and simple!

A few other important things to keep in mind

  • Don’t think of if the program is going to rank you or not when compiling your rank order list. Match algorithm is designed to favor applicants. That means you put programs you want to be in first (based on number 1 and 2 above). Not based on how you think the program is going to rank you. If they rank you and their spots are not filled by applicants ranked before you, your chances to match at that program are 100%
  • Deadline for Rank order list submission is Feb 24, 2016 at 9 pm
  • Rank each and every program you interviewed at on the list. The pain of not matching anywhere is much greater than matching at a program you are not too interested in
  • In USMLE exams, you do not change your answers at the last minute. Same way in ROL do not change your list at the last minute. Think it through well in advance and don’t make any rash emotional decision at the end

There are many other factors like being close to family, weather, size of the program, friends/seniors in the program etc. And they are all important based on your situation. But if you are hard core success oriented person like me then you want to get your foot in the door now instead of waiting one more year and be a year older graduate next match. You should rank the programs based on how they will boost your chances of future success

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