Tilting the Residency Match In Your Favor

Written by: Dr. Ted O'Connell

You have finished your residency interviews, written thank you notes or emails to those who interviewed you, and have determined your rank list for the Match. Now what? How do you tilt the balance in your favor to maximize the chances that you match at your program or programs of choice? The answer is relatively straightforward, yet there seems to be quite a bit of confusion and even conflicting opinion on the topic.

Some students seem to worry that they should not communicate clearly with programs, are not sure what they can say to programs, or think that they are not allowed to make their intentions and desires clear. The National Residency Matching Program (NRMP) does not restrict what applicants say to programs. In fact, here is what they say: “Both applicants and programs may express their interest in each other; however, they shall not solicit verbal or written statements implying a commitment. Applicants shall at all times be free to keep confidential their ranking preferences and the names or identities of programs to which they have or may apply.”

Basically, the NRMP don’t want programs to request applicants to reveal their ranking preferences or induce them into any type of pre-Match commitment. However, this does not limit an applicant’s ability to communicate his/her intentions. Communicating your intentions can be helpful in optimizing the chances that you will match at one of your top choice programs.

What you should do is openly yet strategically communicate with those programs that are most desirable to you. What this means is the following:

  1. For the number one program on your rank list, communicate directly with the program director (or other appropriate contact person) that you will be ranking that program first. Telling a program that you are ranking them first may not have any impact on how you are ranked, or it can have a significant positive impact. A program’s knowing that you really want to train with them may influence them to move you up on their rank list. I am a believer that you should let your number one choice know of your intentions and desires. However, you must do this for only one program and do not deviate from this. See below for details.
  2. For your next tier of programs, communicate with them what you like about the program, what impressed you about the interview day, why the program would be a good fit for you, and what you bring to the residency program. Say that you are “ranking your program highly,” “among my top ranked programs,” or some similar phrase. This communicates your high regard for them and give the program director and selection committee some confidence that they might match with you. At the same time, program directors and selection committees know that “ranking you highly” is nonspecific and doesn’t mean anything at all. You could be saying that to three programs or twenty programs. We all know that we have to discount this phrase. This is why telling your number one choice that they are being ranked first is so important.
  3. For your first choice programs and next tier of programs, consider with whom you might communicate. In addition to emailing the program director, you might consider communicating with a resident or faculty member with whom you bonded during your interview day.
  4. Even for your lower tier programs, you should consider communicating with them via email to maintain contact and stay on their radar. A nice email telling them the details outlined in #2 above but without the phrasing of “ranking your program highly” will make them remember you and may even influence your position on their rank list.

Medicine is a fairly close-knit community, and the specialty to which you are applying will be an even smaller group. If you tell a program that you are ranking them first and they rank you in a position to match, but you then match elsewhere because you actually ranked another program first, this can come back to bite you professionally. You never know when you will cross paths with members of a residency program, and lying to a program’s selection committee can have professional consequences years later. It’s just not worth it. I can’t emphasize this strongly enough. Only tell one program that you are ranking them first, and do not try to mislead anyone.

For reference and further reading, the NRMP’s Communication Code of Conduct can be found here.

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