Creating Your Rank List for Match Day
Created January 16, 2018 by Q Lee, DO
This time of year medical students are beginning to think of where they may match for residency. At this point in the application cycle, most candidates have completed a number of interviews and have an idea of what characteristics make up their ideal program. However, many candidates consider only a handful of major criteria when making their rank list. Some of these include geography, academic vs nonacademic focus, class size, salary, living cost, and opportunities for fellowship. Although these are great factors to think about, they shouldn’t be the only factors residency applicants consider.
Residency training programs last anywhere from 3 years to 7 years, not including subspecialty fellowships. Since you will be committing several years of your life to your program, finding one that fits you well is of monumental importance. Residents from several programs came together to write the following non-exhaustive list of additional factors residency applicants should consider. Two things to remember: 1) ultimately, it is up to you as to whether any or all of these factors are important to you and 2) you may need to do some investigative work to find this information.
1. Attending Availability
Residents who conduct interviews have reported that very few candidates ask about attending availability. To give a little context, the majority of residents who contributed to this article are from community hospitals. At such hospitals, attendings are usually not employed by the hospital and are not available for an entire shift. These attendings will often come in to round with residents, conduct a short teaching session, and leave to round at other hospitals. As a result, residents are expected to take a more independent role in patient care throughout the day. Compare this to an academic program, where attendings are part of the faculty and have more regular hours onsite. More attending availability means more direct guidance and teaching for the residents.
2. Support Capabilities of the Graduate Medical Education (GME) Office
Residency training involves a lot of administrative tasks and paperwork. A strong, dedicated GME office is necessary to assist you in obtaining your medical license and DEA number, securing reimbursement when necessary, and representing you with hospital administration, among other things. Residents at different hospitals have described poor working relationships with their GME office, and the consequences show. Residents are markedly more stressed and less happy at such a program. Complaints from residents have included lack of communication, delayed paperwork, or just hostile working relationship. Asking current residents about their working relationship with the GME staff wasn’t on my mind as a student. As a resident, I would highly encourage interviewing candidates to investigate the support capabilities of the GME office.
3. Resident Autonomy
Students almost never ask me—as a resident—about how much autonomy I have with my patients. Autonomy refers to the extent that residents are allowed to dictate the plan and goal of care for patients. Some programs do not allow residents to order certain labs or medication without prior attending approval. Others allow nearly full autonomy. Resident autonomy varies vary widely from program to program and from specialty to specialty. When I chose to rank my current program, I knew I wanted plenty of autonomy. Like many medical students, I learn best by being directly involved in patient care rather than from lectures. As a resident, I knew I wanted more opportunities to participate in care directly. As a general rule, smaller community or county hospitals are more likely to give residents autonomy with their patients compared to large academic medical centers. Autonomy allows for great learning opportunities but also places great responsibility on residents. Carefully consider what balance of independence and responsibility are right for you.
4. Competition for Procedures
Procedures are plentiful in the hospital setting, but most students don’t consider the competition between residents they may face to log procedures. If you require procedures as part of your residency training, it’s best to consider programs that don’t have too many residents. For example, family medicine residents at academic medical centers may have more difficulty participating in deliveries and minor surgical procedures because of their many co-residents in surgery and ob-gyn. While family doctors rarely deliver babies or perform surgeries in large hospitals, if you intend to practice in rural or smaller hospitals, procedures are a must. A family medicine resident from Tennessee chose his program because he wanted to practice rural medicine. “My program is in an urban setting, but we only have family medicine residents. Essentially we get to perform all procedures.”
5. Staff Support
Responsible and hard working nurses, case managers, and other staff are important. As a resident you are learning how to develop the plan of care for your patients. It is the staff that helps you carry out your plans. Many staff members work well with residents and have the utmost respect for us. However, I have encountered a fair share of issues as well. Residents from programs small and large report problems with different staff departments and their effects on patient care and discharge planning. One working environment was so malignant, “everyone was just ready to write each other up for something. We had very little communication between residents and staff. Residents had to act as their own case managers, and attendings had to report staff members regularly to administration.” While these circumstances are not common, they do exist and you want to make sure the program where you’re interviewing doesn’t have these problems.
Every program has its strengths and weaknesses. Ultimately, it’s up to you to determine what strengths are most important to you in a residency program and what weaknesses you can tolerate. Even when a program has undesirable qualities, you may be able to change some of those yourself. For instance, if a program lacks subspecialty electives, ask program director if they allow residents to set up their own rotations. Chances are good that the program director will appreciate your efforts to make the program better. However, be cognizant of factors which are harder to change. For instance, if you train with certain government hospitals, it’s harder to report wrongdoings and circumvent staff issues. Best of luck to everyone in the Match, and I hope these additional factors help in constructing your rank list. Despite the stresses, Match Day is still one of the most exciting and memorable moments in your life!
About the Author
Dr. Q Lee is a third year resident physician in southern California.