Dilemma

[2008 EM Reviews]

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I think it's semi-hilarious that I'm using this code-name to submit this thread, but nonetheless I do have a dilemma and I'd love some input from active members here, especially residents, attendings, and BKN/any PD's in the group.

Basically, I've narrowed my final rank list down to four great programs. I had told my home program that they were my #1 (met with PD, sat down with him for 5 mins & told him clearly that they were #1). However, it was a big mistake, because at this point they are now my #2 or even #3. I shouldn't have committed so early - there was a bit of pressure on their end - but it was really a big gaffe on my end to commit when I still had two interviews left.

It wouldn't a huge problem if I matched there, and of course I might not even match there. But I really think I found one or two places that I love more, and feel more at home at. I don't want to screw my home program, because I value my word, and still have them #1 on my list. But is it too late to back out, and if so - how do I go about it?

Granted, it wouldn't feel great to write/call this PD and tell him that I've found a better place. But on the other hand, he never gave me any indication of my fit in the program other than saying that I'd gotten favorable reviews. I also don't want to rank them less than first, only to match somewhere else & have them see me as a snake. I'm very confused.

Anyhow, I know a lot of people are posting "help me rank" questions, and posing similar dilemmas. However, if you read this and feel like you might have a little something to contribute, even if it's just a gut feeling, please let me know. I want to be happy where I match, and I want to maintain my integrity while doing so.

Thanks for any help : )

 

[Pinner Doc]

I, too, have told a program that they were my #1. Fortunately, they still are! But still, I've entertained the "what if?" possibilities. I think that if I were in your shoes, I would get in touch with your home PD and let them know you won't be ranking them #1 -- idk that you need to explain why (maybe say that you had spoken prematurely?). I think it's better to be honest than to appear a snake later. Especially since the EM community is pretty small, and chances are you'll work together at some point... and in any case, people talk to each other! (At least, that's what they tell me.)

 

[TysonCook]

Discuss this w/your advisor. They will have some insight.

In the end realize that while a program may want you there, they certainly don't want you there if you don't want to be. For every program there is a perfect match, and its better to rank what you want first, rather than succumb to a rank list that you did to "save face".

Rank #1 where you want to go. There isn't any magic to it.

 

[CueDoc]

Personally, I think you are nuts for only ranking 4 programs. Thats where the real dilemma is. RANK EVERY PROGRAM THAT YOU WOULD RATHER GO TO THAN SCRAMBLE.

 

[GeneralVeers]

Personally, I think you are nuts for only ranking 4 programs. Thats where the real dilemma is. RANK EVERY PROGRAM THAT YOU WOULD RATHER GO TO THAN SCRAMBLE.

Agreed. I ranked 6 programs and didn't match. There have been threads on this forum discussing the "statistically safe" amount of programs needed, and the conclusion was that people who ranked at least 10 programs had a 97% of matching.

After going through the scramble, I can honestly say it's the worst experience of my life. In retrospect I should have applied to more programs, gone to more interviews, and ranked more places.

With 4 programs you had better prepare a scramble plan just in case.

 

[bartleby]

Two thoughts:

If you are only going to rank four programs, you've got much bigger problems with your ROL than what you did or didn't say when you were playing footsie with that PD. Unless you can honestly say that you'd rather go to East ****esville EM Residency over any of the other places you interviewed, you'd better start padding that list past #4.

Do you really think that you're the only person who told the PD that you're going to rank them #1? Get over it.

 

[theCamel]

what's wrong with just letting that program director know that you've found a new #1? it is unlikely that they'll lose much sleep over it, they'll appreciate your honesty, and they might not even change your ranking...

 

[jazz]

not sure if you're only planning to rank 4 programs -- i would rank almost all the ones i interviewed at unless there are some that were just horrible and you would rather scramble... you won't get your 7th choice unless the 6 above didn't want you....

we were always told as medical students that you should never tell someone they are your 1st choice unless you make that happen. the dean of the medical college used to say this and imply they would make your life difficult if another school complained that you told them they were number 1 and then didn't rank them 1st. how much is true? who knows? however, just remember EM is a small world and if the attendings at your home program feel slighted.... they have friends(people they went to residency with and are now EM attendings elsewhere)... and it may not effect you now but in 3-4 years when you are looking for a job-- you don't want to be described as someone who is "untrustworthy" or a "snake" or whatever.....

i would either ask your advisor for advice or the PD. you can just say something like --putting the rank list is much harder than you previously thought, changes daily etc, and you're not sure the list is going to look the same as it did when you talked to them last... and hope they get that you're not putting it 1st... or just point blank say -- i think i found a few better fits-- i would still love to match here but it's now my #2-3

 

[Dr.Evil1]

You should rank according to where you want to go. I had a program where I rotated push hard for me to rank them #1 but I knew that I liked a couple of other programs better. I ended up ranking the program across town higher and matched there. One person at that program had some hard feelings for me but it has never really affected me. That PD isn't going to be able to affect you getting a job and it won't affect the training that you get at the program that you match at. The match is designed to help you, the medical student. It was designed to prevent just the situation that feel like you are trapped in. Rank your home program number 3 and don't give it a second thought. Be happy no matter where you end up. Rank everywhere you think that you could be happy too, don't stop at 4.

 

[deleted109597]

Unless you can honestly say that you'd rather go to East ****esville EM Residency over any of the other places you interviewed, you'd better start padding that list past #4.

You people are delusional. Screw getting an EM residency, if you don't match EM (Or OB, or Surgery, or ....) you simply ain't getting a job in it. You will be able to get prelim IM, Surgery, some transitional years, and FM and IM.

Last year there were 6 jobs left after the match. At 2 places.

 

[Dr. Dukes]

Last year there were 6 jobs left after the match. At 2 places.

Where were they?

 

[deleted109597]

Where were they?

Las Vegas and Michigan State.

 

[bartleby]

what's wrong with just letting that program director know that you've found a new #1?

Individually, you do not benefit from this sort of communication. If you're super interested in a program, should you reach out to them and let them know that you're serious about them? Sure. But getting into the specifics of your rank list does not benefit you for a variety of reasons, one of which is that you can paint yourself into a corner with excessively specific promises you might not keep. At worst, the PD could be peeved and drop your position on their list low enough that you will not rank there at all.

 

[bartleby]

A link from the NRMP explaining what consistutes a match violation:

http://www.nrmp.org/res_match/about_res/ensuring.html

 

[theCamel]

A link from the NRMP explaining what consistutes a match violation:

http://www.nrmp.org/res_match/about_res/ensuring.html

"Applicants and program directors may express a high degree of interest in each other and try to influence decisions in their favor, but must not make statements implying a commitment. Although the Match Participation Agreement does not prohibit either an applicant or program director from volunteering how one plans to rank the other, it is a violation to request such information. Program directors and applicants frequently engage in the practice of sending letters following the applicant's interview with the program. Those letters often contain statements that can be misinterpreted by either party. Match participants must understand that such letters are not binding and have no standing when final rank order lists are submitted."

 

[Egon]

I think there's 2 days left for the PDs to put in the lists. Actually, most lists are in, they just will get certified.

I wouldn't bother telling your home PD they're not "number one" any more. They may not have put you in the guaranteed match spot either, and there are stories of PDs saying you're "ranked to match", meaning you're within the usual match spots, and the list will only go 15 deep. But there's probably a decent chance you may end up at your home program anyway, so no reason for bad blood before you start.

In general, it's best to just say that you really love the program and are ranking it highly to avoid any promises, etc.

Also, in terms of ranking it's best to put down all the places you would rather be vs not training in the field. The EM scramble is probably more competitve than the match in terms of applicants for spots...

 

[bulgethetwine]

I think it's semi-hilarious that I'm using this code-name to submit this thread, but nonetheless I do have a dilemma and I'd love some input from active members here, especially residents, attendings, and BKN/any PD's in the group.

Basically, I've narrowed my final rank list down to four great programs. I had told my home program that they were my #1 (met with PD, sat down with him for 5 mins & told him clearly that they were #1). However, it was a big mistake, because at this point they are now my #2 or even #3. I shouldn't have committed so early - there was a bit of pressure on their end - but it was really a big gaffe on my end to commit when I still had two interviews left.

It wouldn't a huge problem if I matched there, and of course I might not even match there. But I really think I found one or two places that I love more, and feel more at home at. I don't want to screw my home program, because I value my word, and still have them #1 on my list. But is it too late to back out, and if so - how do I go about it?

Granted, it wouldn't feel great to write/call this PD and tell him that I've found a better place. But on the other hand, he never gave me any indication of my fit in the program other than saying that I'd gotten favorable reviews. I also don't want to rank them less than first, only to match somewhere else & have them see me as a snake. I'm very confused.

Anyhow, I know a lot of people are posting "help me rank" questions, and posing similar dilemmas. However, if you read this and feel like you might have a little something to contribute, even if it's just a gut feeling, please let me know. I want to be happy where I match, and I want to maintain my integrity while doing so.

Thanks for any help : )

You're agonizing over nothing. At our program, I can't even begin to tell you how many have told our PD some variation of "you're my #1", "you're in my final top choices", "you're in the top 2!"....

Seriously. We don't care. We rank who we want in order of who we can work with, who is likely to be teachable, and all the other intagngibles. You think we go back and check off, of those who said they ranked us #1, whether or not they matched with us if we ranked them in our top dozen? If you weren't there and we ranked you in our top 5 (gasp), you think we then start calling 'round to see where you matched so we can tell your new PD that you 'burned us'?!?!?

Hell, we're busy enough calling the ones that DID match, welcoming them, and putting together the e-mail with your picture that goes out to all the other faculty.

I know you meant this because you sincerely don't want to piss off your home PD. And I'm not trying to sound condescending, but you will look back on this and laugh at how you were "sweating the small stuff".

Oh, unless you only rank 4 programs. Then you might look back on this whole experience with frank diaphoresis (gulp).

Good luck.

 

[Fletcher]

I know this is an old thread but if I were in this situation I would stop by the directors office and say:

"Hi Dr____, as the rank list season approaches I wanted to let you know that I am re-evaluating my rank order list, but am still very interested in this program and plan to rank it highly."

My reason- you are creating connections with every interaction, and in the end your honor and integrity is all you have. You never know when you will want advice/help from your home program, and they may get phone calls someday from prospective employers.

 

[bulgethetwine]

I know this is an old thread but if I were in this situation I would stop by the directors office and say:

"Hi Dr____, as the rank list season approaches I wanted to let you know that I am re-evaluating my rank order list, but am still very interested in this program and plan to rank it highly."

My reason- you are creating connections with every interaction, and in the end your honor and integrity is all you have. You never know when you will want advice/help from your home program, and they may get phone calls someday from prospective employers.

Holy thread resurrection, Batman!

But a timely bump anyway as many are now re-tooling their rank list based on what they saw during their interviews.

Good luck, everyone.

BTT

 

[dotcb]

I'm a 2nd year EM resident. Rank the programs in the order in which you want to attend them. It's really that simple.

 

[roja]

For what it is worth:

You do not need to go and recommunicate with your home PD. Any PD knows that things change as people go places and that what is most important is that students end up where they will fit best.

You can have a discussion, if you feel its really important, after match.

You should definately consider ranking more places. You are getting sound advice here. Scrambling is not fun.

most of us put a few programs on our list that for one reason or another were not our perfect match but that we would rather go to than not match. I only no ranked two places. If you interview, unless you have some dramatic reason for not going there, you should rank them.


*** and most importantly, do you rank list based on where you want to go. period.