Must Read!! How The Match Works

[DrNick2006]

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I consider myself reasonably informed, but up until just recently I apperently did not fully understand how the match worked, but then a PD on one of my interviews explained it to me, and what I learned was important so please read on.

Like many of you, I was concerned about ranking a program that I felt was a stretch for me first because I thought it may comprimise my chances at other places. The reason I thought this was because I was under the impression that the way the match worked was that If my ROL was this: (which it isn't cause I didn't interview at any of these places)

1. MGH where I think I am way down thier ROL
2. JHU where I think I am in the middle

If I ranked MGH first, then the match would look for my name on their ROL and I would match there if it was UNLESS enough people above me on MGH ROL also listed them first and had filled up all the available residency positions. Lets assume that happend. Now, my understanding was that after all the #1's were looked at for all medical students, all the medical students and slots who matched were taken out and the whole process was repeated again for each meidical student's #2 spot.

My concern was that while I ranked MGH #1 and didn't match, many people ranked JHU first and did match, perhaps a lot who were lower than myself on the JHU ROL, so while I was higher than these people on JHU ROL, I had missed out because I did not put them first. Now that round 2 came, perhaps not enough slots would be left and I would have lost out on JHU as well.

THIS IS NOT HOW THE MATCH WORKS!!!! There are no rounds to the match. What really happens is if you do not match at your #1, your #2 BECOMES your #1. So, in the above example, if I did not match at MGH, JHU would now become my #1, and as long as there were more spots than people above me on JHU ROL who had JHU as thier #1, either new or old, I would indeed match at JHU. And remember, I need not be too high on JHU ROL because many of the people above me may have matched to thier first choice which was not JHU and removed themselves from JHU's ROL.

I hope the above was not too confusing, the practical point is that it CANNOT HURT YOU to rank your top chice first, no matter how much of a stretch it is for you. The match is set up for our benifit.

If you found this explination helpful please comment to keep the thread alive for others.

 

[fantasty]

Your explanation is fine, but honestly I don't think that it's that complicated to understand if you read the information on the NRMP website:
http://www.nrmp.org/res_match/about_res/algorithms.html

 

[pdintheusa]

I just made a similar post in another read, but the OP is absolutely correct!

Shoot for the stars! Not doing so cheats you out of the very best chance you have at getting into that program. I also worry that you may end up just a little less happy where you end up because you'll always wonder if you could have gotten into the place you truly wanted to be.

It is so frustrating to me when applicants aren't told this outrightly. I think it reflects poor advising many times. I can't tell you how many times I hear of folks ranking a certain place #1 just because they are told by PD's that they are going to be ranked at the top.

Put your ROL based on exactly where you want to be, not where you think the program will put you. Let the computer figure out where the match falls out!

Good luck!

 

[deleted4401]

I went with that thought process last year, but the second time through I have some doubts. Not with the algorithm - you're absolutely correct. In a perfect world where a PD has no idea where the student is ranking them and vice versa, it works out for the student.

The problem arises when this "Letter of intent"/"You're my first choice" business is involved. Last year: I ranked a program first for rad-onc and let them know about it. It was probably the best program that I interviewed at, and somewhat sought after. I didn't match. At an interview this year, I found out I was #2 on the rank list at another program (they told me this; my stomach sank hearing it), but they got their first choice. Had I contacted that program and ranked them first, and they decided they did not want to go down their list, so they switched me over to #1, I may have matched. I'm not saying that would have happened, but based on what I've heard from program directors this year, a letter of intent can very well change your rank position. I was told by one program that it most definitely would change my position, and that I should get in contact with them if they were my first choice.

So ... I think in the larger specialties, i.e. IM or EM or GS, maybe you should really go with your preferences, but in the smaller fields maybe there should be some strategy involved.

Just my thoughts,
S

 

[CTKN2]

-- yup, that's what I've been trying to tell people too, but there is so much skepticism! read the match algorithm on the nrmp website, and you'll realize that you really should rank programs based on where you want to go! thanks for the post, DrNick2006

 

[sbill1]

I found objective evidence that ranking your preferred program is not always the best strategy from an article published by the NRMP that analyzed several match scenarios and concluded the following.

Markets with match variations can be constructed for which: no stable matchings exist8; no optimal stable matchings for either side exist (even when stable matchings exist14) and therefore; no algorithm always produces an "optimal" stable matching for either side of the market. Furthermore, different stable matchings may have different applicants unmatched and positions unfilled, and no algorithm always guarantees applicants that stating their true preferences is an optimal strategy.

The article did state that these were rare scenarios (1 in 1000), but given the discussion about the personal element that comes into play with the "Intent to Rank" factor, maybe ranking your true preference is not always the best strategy if you intend to use that sort of leverage.

The Effects of the Change in the NRMP Matching Algorithm

By Alvin E. Roth, Ph.D., University of Pittsburgh, and
Elliott Peranson, M.A.Sc., National Matching Services Inc.
Revised, June 5, 1997

 

[lloyd braun]

This is pretty scary. I wonder how many people really don't understand how the match works. Yikes! Do your research, people!

 

[CJamblooze]

I think it's fine to submit a "first choice" letter. If a program is trying to decide between two equal candidates, they are going to prefer to have someone that is gung ho about their program.

 

[EspiritDeCorps]

I have heard similar stories several times that a letter of intent (or declaring your #1 choice) can bump you up on a rank list. I understand that the programs want people who want to be at their program. However, they will get people who want to be at their program no matter what, because whoever matches to their program obviously ranked them, and most likely ranked them high on their ROL. Strictly speaking, the program that changes their rank list of applicants based on letters of intent, is not getting the best applicants they can get. In contrast, they are recieving applicants who know how to play the game better and also may desire that program more strongly (which I'm not sure if this equates to being more happy and more loyal in the long run at the program). So why do programs take letters of intent into consideration?

 

[uclabruins47]

does letter of intent matter at all for IM where some program sizes are really large?

 

[Trepp]

I have heard similar stories several times that a letter of intent (or declaring your #1 choice) can bump you up on a rank list. I understand that the programs want people who want to be at their program. However, they will get people who want to be at their program no matter what, because whoever matches to their program obviously ranked them, and most likely ranked them high on their ROL. Strictly speaking, the program that changes their rank list of applicants based on letters of intent, is not getting the best applicants they can get. In contrast, they are recieving applicants who know how to play the game better and also may desire that program more strongly (which I'm not sure if this equates to being more happy and more loyal in the long run at the program). So why do programs take letters of intent into consideration?

We aren't talking about a program comparing a FMG with 185 board score with a US grad with 240 and AOA. If a program has two candidates that are practically the same except that one really really wants to go there, then the program is probably doing themselves a favor by ranking the one who is interested higher. Of course you could argue that just because you want to go somewhere doesn't mean that you will actually like it better once you get there...

 

[marshmallows]

I consider myself reasonably informed, but up until just recently I apperently did not fully understand how the match worked, but then a PD on one of my interviews explained it to me, and what I learned was important so please read on.

Like many of you, I was concerned about ranking a program that I felt was a stretch for me first because I thought it may comprimise my chances at other places. The reason I thought this was because I was under the impression that the way the match worked was that If my ROL was this: (which it isn't cause I didn't interview at any of these places)

1. MGH where I think I am way down thier ROL
2. JHU where I think I am in the middle

If I ranked MGH first, then the match would look for my name on their ROL and I would match there if it was UNLESS enough people above me on MGH ROL also listed them first and had filled up all the available residency positions. Lets assume that happend. Now, my understanding was that after all the #1's were looked at for all medical students, all the medical students and slots who matched were taken out and the whole process was repeated again for each meidical student's #2 spot.

My concern was that while I ranked MGH #1 and didn't match, many people ranked JHU first and did match, perhaps a lot who were lower than myself on the JHU ROL, so while I was higher than these people on JHU ROL, I had missed out because I did not put them first. Now that round 2 came, perhaps not enough slots would be left and I would have lost out on JHU as well.

THIS IS NOT HOW THE MATCH WORKS!!!! There are no rounds to the match. What really happens is if you do not match at your #1, your #2 BECOMES your #1. So, in the above example, if I did not match at MGH, JHU would now become my #1, and as long as there were more spots than people above me on JHU ROL who had JHU as thier #1, either new or old, I would indeed match at JHU. And remember, I need not be too high on JHU ROL because many of the people above me may have matched to thier first choice which was not JHU and removed themselves from JHU's ROL.

I hope the above was not too confusing, the practical point is that it CANNOT HURT YOU to rank your top chice first, no matter how much of a stretch it is for you. The match is set up for our benifit.

If you found this explination helpful please comment to keep the thread alive for others.

yes but what about the spots at your number 2,. if u don't rank them number 1, and dont match at ur number 1, then what if more people ranked your number 2, and the spots then tend to fill up more quickly, would u miss out bc you didn't rank your number 2 or 3, etc. higher? in other words if you are unsure you will match to your number 1, then should you still rank it number 1?

i just confused myself

 

[FaceReality]

haha, dr nick you just confused yourself!! i thought the same thing that you thought and what the original poster originally thought!

here is my understanding based on reading the NRMP website.....

you only tentatively match to a program if there are openings or if you rank higher than people who are tentatively matched there. that implies, that if you dont get your number 1, your number 2 automatically becomes your number one. so if you rank program A #3 on your list, but your buddy ranked it #1, but you are ranked higher on the programs rank order list, you will get that spot if you did not get your number 1 and 2 and you will bump your buddy off.........irregardless of if there is openings or not. thats my understanding, so correct me if im wrong.

some people think that you only have one #1 and that you should rank the program that you have the highest chance at #1 in order not to lose it. But that is incorrect from my understanding. What really determines where you will end up is how you are ranked on a programs rank order list and whether people above you on the programs rank order list match somewhere else or not. IF they match elsewhere, it will come down to you and you will match there pending you ranked them number one or did not rank into your top choices.

so here is a hypothetical........

A program has one spot left to match. Student A ranks a program #1 but is ranked 22 on the programs rank order list, and Student B ranks the same program #2 but is 21 on the programs rank order list. So who gets the spot? I used to think that student A gets the spot because he wants it more and thus ranked it #1. But that is not the case. If Student B does not match into his #1, he will actually get the spot because he is higher on the programs rank order list and he can thus bump off Student A from the list.... Its an implicit thing, but your number 2 becomes your number 1 if u dont match your original number 1.

So in reality, it kinda feels like the programs have the upper hand in getting who they want.

I would love to hear someone correct me if I'm wrong.
Thanks,
-FR

 

[Chinnychin]

The match really works in favor of both applicants and programs but in different ways.

Applicants have the advantage for not being penalized for trying to get their top spots without sacrificing their chance at their "safety programs". This is a huge advtange, atleast to me and anyone in my shoes-There is 2 programs I know for a fact I will have a spot-however there are 2 others I would rather go to and are much more competitive. Now without the match and I went for those-if I did not match at them and in the first 2 rounds the slots at my safety's were filled-then I am unmatched.

Programs benefit because they get the best possible residents that they could have and are not "stuck" with any less desirable ones. They maximize their chance of getting more of their top picks due to the "bump" system. So even in the last round, if their number one applicant ranked them 10th-but that applicant got rejected from his first 9-then the program ends up with their top pick-when without this sytem their spots would have been long filled by this round.

So we both get benefits-I think the students benefit comes with little/no downside. However programs downside is losing those people who rank them lower because they consider them "Safety"s where as without this system, I know many people, including myself that would not risk not matching and take my safety pick and the program would get more of the quality applicants this way.
See another example is this-say there is a super applicant (step 240 etc) and he ranks 3 programs A, B, C. Say A is super competitive(like harvard neurosurgor whatever), and B is good and C is the worst (but still desirable)-now If applicant was assured he would get into C-then with the system their is less likely a chance program C will get him. However if the match did not exist there would be a lot more of a chance of program C getting him if the applicant knew he might very well not match into his top 2 and does not want to end up unmatched so takes c

 

[EspiritDeCorps]

We aren't talking about a program comparing a FMG with 185 board score with a US grad with 240 and AOA. If a program has two candidates that are practically the same except that one really really wants to go there, then the program is probably doing themselves a favor by ranking the one who is interested higher. Of course you could argue that just because you want to go somewhere doesn't mean that you will actually like it better once you get there...

Good point Trepp. It probably does make more of a difference when splitting hairs between very similar applicants.

 

[FaceReality]

Just like we have nothing to lose by ranking our dream programs number one, programs have nothing to lose by ranking all of their top choices at the top. I think programs want to rank as many interested people as possible. but ultimately i think what determines where you end up on the rank order list is their numerical score or whatever they give that is based on the school you went to, your board scores, letters, clinical grades, and of course how well you were liked on the day of the interview. those are the biggest determining factors to how high you are on a programs rank order list.

if i were a program director, i would rank the people with the best qualifications the highest paying particular attention to people that I believed would be able to handle the stress of my particular program and excel. there are many things that can contribute to stress.... not limited to but include location.... do you have family in the area? what are your coping mechanisms for stress? can you fit into the area and program? these are all huge factors that contribute to your happiness as well as the PD's. I personally believe that PD's rely too heavily on family ties to an area etc to gauge interest. I think genuine interest is easy to pick up...

I believe the NRMP is correct, both applicants and programs need to create a strong sized list and rank according to preference.

The other point i wanted to make is the idea of showing interest. If you're interested in matching into a certain program, you should make that clear on the day of the interview. If that is made clear, I don't see how doing a second look is going to show even more interest. At that point, it's really at the discretion of the PD to bump you higher on the list or not... if you are well liked, you will go up on the list regardless of if you come for a 2nd look or not. Thats my take on it.

All in all, who really knows? I'm REALLY sick of this process! I cant wait until this process is over so then I can worry about my tan for a month and a half before I begin the brutal intern year!