Program Rank #1 Advice Needed

[d0cintheb0x]

Hey everyone, I'm a medical student and I need some advice. So, a while back, I took part in a PD question answer panel at my base hospital. Almost all of the PDs agreed that it is best to send an email saying basically "hey I'm ranking you #1 in the rank process". I misunderstood and thought that I should send that email as soon as I'm "sure" that I'm ranking them #1. Needless to say, the EM program at my base institution was my top interest at the time after auditioning there so I sent an email saying thanks for the audition and "As things stand, your EM program is my number 1 in terms of rank order, and I don't foresee that changing. I will keep in touch about how things go with other hospital auditions and if anything changes." Yes, I understand this was a foolish email to send this early in the process.
After auditioning a few more times and making my way through all of my EM interviews, I have realized that I may like other programs better than my base hospital. I'm wondering if or how I should tell the program I may not be ranking them #1. If I say nothing and I match there, no harm, no foul. If I say nothing and don't rank there, I feel like I lied to them. Any advice?

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[Giovanotto]

Hey everyone, I'm a medical student and I need some advice. So, a while back, I took part in a PD question answer panel at my base hospital. Almost all of the PDs agreed that it is best to send an email saying basically "hey I'm ranking you #1 in the rank process". I misunderstood and thought that I should send that email as soon as I'm "sure" that I'm ranking them #1. Needless to say, the EM program at my base institution was my top interest at the time after auditioning there so I sent an email saying thanks for the audition and "As things stand, your EM program is my number 1 in terms of rank order, and I don't foresee that changing. I will keep in touch about how things go with other hospital auditions and if anything changes." Yes, I understand this was a foolish email to send this early in the process.
After auditioning a few more times and making my way through all of my EM interviews, I have realized that I may like other programs better than my base hospital. I'm wondering if or how I should tell the program I may not be ranking them #1. If I say nothing and I match there, no harm, no foul. If I say nothing and don't rank there, I feel like I lied to them. Any advice?

Can anyone confirm this?

 

[gyngyn]

Can anyone confirm this?

Am email (toward the end of the season) that indicates that you have decided to rank a program #1 can be recommended.
Programs cannot elicit this information, though.

 

[Giovanotto]

Am email (toward the end of the season) that indicates that you have decided to rank a program #1 can be recommended.
Programs cannot elicit this information, though.

What's preventing me from sending every program this email? Why is everything in the application process so silly?

 

[longhaul3]

What's preventing me from sending every program this email? Why is everything in the application process so silly?

Every program knows where you are on its rank list. If you rank a program #1 and they rank you to match, you will match there. So if you lie about it and don't match at a program that ranks you to match, they know you lied, and it's a really bad look. At least in my small specialty, this can have serious implications for your career.

 

[Postictal Raiden]

Am email (toward the end of the season) that indicates that you have decided to rank a program #1 can be recommended.
Programs cannot elicit this information, though.

The inbox of every PD in this country will explode by tomorrow morning, thanks to this comment.

 

[LoGo]

 

[Tenk]

Nobody cares. Just don’t send out another one. Rank them however you want. To make you feel better, these don’t matter. I was in my PDs office one day during interview season and he was like look at this crap. He turned his computer and it’s just email spam from applicants. He just deleted them all.

 

[Newyawk]

Nobody cares. Just don’t send out another one. Rank them however you want. To make you feel better, these don’t matter. I was in my PDs office one day during interview season and he was like look at this crap. He turned his computer and it’s just email spam from applicants. He just deleted them all.

Cuz all PDs are replicas of each other

 

[Tenk]

Cuz all PDs are replicas of each other

No, but they all get these types of emails on a daily basis. Thus, they have little to no effect especially in a competitive field like EM.

 

[Newyawk]

No, but they all get these types of emails on a daily basis. Thus, they have little to no effect especially in a competitive field like EM.

EM is competitive but also has tons of apps. Perhaps not generalizable to surgical subs and other smaller fields

 

[Tenk]

EM is competitive but also has tons of apps. Perhaps not generalizable to surgical subs and other smaller fields

Should probably read the op. They specifically mention EM. Dunno why you’re getting into theory crafting land of surgical sub spec but since your example is with surgeons, they would most certainly be annoyed and delete them all. Then they’d call in the intern to turn off the computer and close their office.

 

[Newyawk]

Should probably read the op. They specifically mention EM. Dunno why you’re getting into theory crafting land of surgical sub spec but since your example is with surgeons, they would most certainly be annoyed and delete them all. Then they’d call in the intern to turn off the computer and close their office.

My original point still stands. You havent met every EM PD, even if as a group they are more likely to not have time to read all of their emails

 

[Tenk]

My original point still stands. You havent met every EM PD, even if as a group they are more likely to not have time to read all of their emails

I can 100% guarantee I have met far more EM PDs than you have. Don’t worry though, I have been meeting them like Pokémon and one day I will catch them all.

 

[hallowmann]

Don't send another one. Don't send a "oh, you're not my number 1 anymore" email, that's just silly. Like others have said, it's wildly variable depending on program whether these are helpful or not. Emailing a number one isn't going to hurt you if they don't care, and it might help you if they do. Just don't email more than 1 program that.

By the way, some programs do this all the time. Just ignore them, and rank how you would regardless of that communication.

 

[Tenk]

By the way, some programs do this all the time. Just ignore them, and rank how you would regardless of that communication.

This is very important. Always rank based on your liking, not based on how a program told you they would rank you. It's in a programs best interest to have everyone rank them #1.

 

[sella.turcica]

Hey everyone, I'm a medical student and I need some advice. So, a while back, I took part in a PD question answer panel at my base hospital. Almost all of the PDs agreed that it is best to send an email saying basically "hey I'm ranking you #1 in the rank process". I misunderstood and thought that I should send that email as soon as I'm "sure" that I'm ranking them #1. Needless to say, the EM program at my base institution was my top interest at the time after auditioning there so I sent an email saying thanks for the audition and "As things stand, your EM program is my number 1 in terms of rank order, and I don't foresee that changing. I will keep in touch about how things go with other hospital auditions and if anything changes." Yes, I understand this was a foolish email to send this early in the process.
After auditioning a few more times and making my way through all of my EM interviews, I have realized that I may like other programs better than my base hospital. I'm wondering if or how I should tell the program I may not be ranking them #1. If I say nothing and I match there, no harm, no foul. If I say nothing and don't rank there, I feel like I lied to them. Any advice?

Based on the other replies, the PD might not even have read it. Relax, everything's going to be fine.

 

[Deecee2DO]

No, but they all get these types of emails on a daily basis. Thus, they have little to no effect especially in a competitive field like EM.

Would you even call EM competitive? Plenty of people with average Step 1 scores and no research (yes i know its not research heavy field but still competitive specialties are) from almost any DO program match EM every year. Maybe things have changed and im not up to date

 

[Tenk]

Would you even call EM competitive? Plenty of people with average Step 1 scores and no research (yes i know its not research heavy field but still competitive specialties are) from almost any DO program match EM every year. Maybe things have changed and im not up to date

It's not neurosurgery or derm competitive but it's definitely gotten more competitive over the last 10+ years because it's one of the best lifestyle specialties.

One of my favorite older attendings who was in one of the very first EM programs in the country put it best: “I look at these applicants and their board scores and I’m amazed. If I applied EM today, I sure as hell wouldn’t get in.” Ironically, he was everyone’s favorite attending and crazy good at what he did.

 

[Deecee2DO]

It's not neurosurgery or derm competitive but it's definitely gotten more competitive over the last 10+ years because it's one of the best lifestyle specialties.

One of my favorite older attendings who was in one of the very first EM programs in the country put it best: “I look at these applicants and their board scores and I’m amazed. If I applied EM today, I sure as hell wouldn’t get in.” Ironically, he was everyone’s favorite attending and crazy good at what he did.

2 questions now. 1. Would you consider it a ROAD specialty bc of the lifestyle and 380+ salary? 2. Why is gas so “UNcompetitive” when salary and lifestyle are so good?

 

[ciestar]

2 questions now. 1. Would you consider it a ROAD specialty bc of the lifestyle and 380+ salary? 2. Why is gas so “UNcompetitive” when salary and lifestyle are so good?

CRNAs

 

[Ho0v-man]

I love that programs are allowed to send these types of emails to basically everyone and no one cares but applicants are unprofessional for doing the same.

 

[Angus Avagadro]

This is very important. Always rank based on your liking, not based on how a program told you they would rank you. It's in a programs best interest to have everyone rank them #1.

The above is must hear advice! Reports from my students and posts on SDN are replete with stories of students informing a program they are their #1 choice and the PD responds" You have made my day"! Then the student doesnt match there. PDs are notorious for giving out misleading information. Some out of their self interest and some out of being compassionate to the student, and because Acgme doesnt allow them to reveal their rank list to you.
Bottom line, rank based on your fit and how the program will advance your career.

 

[Tenk]

2 questions now. 1. Would you consider it a ROAD specialty bc of the lifestyle and 380+ salary? 2. Why is gas so “UNcompetitive” when salary and lifestyle are so good?

1. Probably not. EM is its own double edged sword with huge positives and huge negatives. It’s more the ultimate work hard, play hard specialty.
2. Probably fear of CRNAs as mentioned above.

 

[CyrilFiggis]

I’ve had more than one EM PD on the trail this year tell me to send/don’t send those emails or send/don’t send thank you cards/emails. It’s a mixed bag.

OP, you sent that message after your first rotation this summer, the PD knows you had very little comparison and probably wasn’t 100%. If come end of January you still thought your home program was numero uno, I would follow up, but otherwise, stay silent.

Also, it’s worth noting, there are cases when emailing a PD is valuable. Last year one of my classmates who lived and studied her whole life within 50 miles of our school had their fiancé get his dream job in DC. She found out after her interview and emailed the PD to say she was ranking their program #1 in part because of this. If it’s more than lip service, there is value in it.

 

[Rekt]

Ash Ketchum over here thinks they mean jack squat. Meanwhile I and many others have been told otherwise and have received responses to our letters of intent in multiple fields.

Just because you get a response to an LOI, it doesn't mean anything. Every single year there's people posting on here and elsewhere saying they sent an LOI and got an essential LOI back and they don't match there.

I'm also EM and like @Tenk 's program we put all LOIs and thanks yous directly in the trash. They're pathetic.

 

[ciestar]

So what is the actual thing to do here? In mid-January let my #1 know they’re my number #1?

 

[Newyawk]

Just because you get a response to an LOI, it doesn't mean anything. Every single year there's people posting on here and elsewhere saying they sent an LOI and got an essential LOI back and they don't match there.

I'm also EM and like @Tenk 's program we put all LOIs and thanks yous directly in the trash. They're pathetic.

Yall are trash if you think theyre pathetic. A genuine LOI should be acknowledged. Not surprising coming from EM folk though.

 

[Scrubs101]

Just because you get a response to an LOI, it doesn't mean anything. Every single year there's people posting on here and elsewhere saying they sent an LOI and got an essential LOI back and they don't match there.

I'm also EM and like @Tenk 's program we put all LOIs and thanks yous directly in the trash. They're pathetic.

Idk man considering them pathetic is a bit much. I get throwing them out, or ignoring them if you dont consider them at all. But genuinely looking down on an applicant for trying everything possible to have some minuscule control/effect over the next 3-4yrs of their life is quite jaded.

Now if they were an applicant that goofed off their whole audition, ****ed around during the interview, and straight up admitted to not liking your program then sent a LOI...thatd be pathetic. But im gonna go ahead and assume the vast majority of people are truthful with their LOI’s, may just be the naive M3 in me though.

 

[WheezyBaby]

Post interview communication should just be prohibited from both sides with exceptions of questions from applicants to programs and updates from programs sent universally to all applicants. The games are silly

 

[Oedipa Maas]

Idk man considering them pathetic is a bit much. I get throwing them out, or ignoring them if you dont consider them at all. But genuinely looking down on an applicant for trying everything possible to have some minuscule control/effect over the next 3-4yrs of their life is quite jaded.

Now if they were an applicant that goofed off their whole audition, ****ed around during the interview, and straight up admitted to not liking your program then sent a LOI...thatd be pathetic. But im gonna go ahead and assume the vast majority of people are truthful with their LOI’s, may just be the naive M3 in me though.

Agreed. I don't see how sending a letter saying "Please know that I would be happy to work with you and will be ranking you number one" is pathetic. Depending on the applicant, shouldn't someones active desire to be in a certain place have an impact? I'll be working hard in residency no matter what because I want to be a competent, effective physician. However, if I am all around more content and well in a certain place, I will be more willing to go the extra mile for things that aren't necessarily important to my learning but may benefit a colleague or the program. When I think back to my rotations on services with off-service residents, I much preferred to work with those who actively wanted to be there as opposed to those who were fulfilling a requirement.

 

[Tenk]

Yall are trash if you think theyre pathetic. A genuine LOI should be acknowledged. Not surprising coming from EM folk though.

Idk man considering them pathetic is a bit much. I get throwing them out, or ignoring them if you dont consider them at all. But genuinely looking down on an applicant for trying everything possible to have some minuscule control/effect over the next 3-4yrs of their life is quite jaded.

Now if they were an applicant that goofed off their whole audition, ****ed around during the interview, and straight up admitted to not liking your program then sent a LOI...thatd be pathetic. But im gonna go ahead and assume the vast majority of people are truthful with their LOI’s, may just be the naive M3 in me though.

So, like you, when I was a medical student, I thought things like this MATTERED. Key word: mattered. Meaning, made a difference. Having seen this process from both sides, I can tell you out of all your application things like this matter the least, if it all. Why? Your peers. Put yourself in the shoes of a PD. They get bombarded with these emails all the time. “You’re the best program!” “I’m ranking you #1!” “It’s my dream to come there!” Then match day comes and NONE of these people match at your program. They basically lied. I saw it all the time. But the PDs know this, so they don’t put weight in them. They also want the best possible program possible, so they will choose the best applicants, not just people who emailed them. All your peers have a narrative and some of them will be a lot better than others, you just never know that because you aren’t reading their applications and weren’t at their interviews.

Take home: don’t put much weight in letters either way. Just because you send an email and the PD doesn’t respond, doesn’t mean you won’t match there. Just because you send an email and they say: “You’re our #1 applicant!!!” Doesn’t even mean they are going to rank you at all. If it makes you feel better, send them but if you don’t get a reply it doesn’t actually mean anything.

 

[Tenk]

So what is the actual thing to do here? In mid-January let my #1 know they’re my number #1?

If it helps you sleep, go for it. Just know you might get any range of responses from absolutely nothing to saying you’re our #1. None of these matter until match day though.

 

[Rekt]

Yall are trash if you think theyre pathetic. A genuine LOI should be acknowledged. Not surprising coming from EM folk though.

Imagine insulting an entire specialty because someone hurt your feelings.

 

[Newyawk]

Imagine insulting an entire specialty because someone hurt your feelings.

Didnt hurt my feelings, dont care about you or tenk.

 

[FalconSlice]

They do matter in certain circumstances. In smaller fields/programs where the resident class is 5-10 people, programs care who wants to be there. One unhappy resident can hurt the culture. I have heard this from multiple advisors and a few PDs. Not going to claim that EM PDs care, because I dont know them. Calling these letters “pathetic” when many of them are from students showing genuine interest in the program is obnoxious.
Wishing yall a happy new year anyways.

No offense, but a med student's opinion on how institutions receive doesn't mean as much as a faculty member's. Furthermore, one can't control how LOIs are received no matter how one might love/hate it. If you send LOIs and 1.) the PD laughs at your pathetic note while lighting it on fire with a zippo lighter...or 2.) if he/she frames it in a shrine, neither situation will be known to you or matter.

Personally, I think a LOI is a lavishly made toilet paper... it's going down the drain anyway, but it's nice and beats that one-ply crap

 

[ciestar]

If it helps you sleep, go for it. Just know you might get any range of responses from absolutely nothing to saying you’re our #1. None of these matter until match day though.

I wasnt planning on doing this so i just wont then

 

[VincentAdultman]

They do matter in certain circumstances. In smaller fields/programs where the resident class is 5-10 people, programs care who wants to be there. One unhappy resident can hurt the culture. I have heard this from multiple advisors and a few PDs. Not going to claim that EM PDs care, because I dont know them. Calling these letters “pathetic” when many of them are from students showing genuine interest in the program is obnoxious.
Wishing yall a happy new year anyways.

In my program (class of 4/year) a “you’re my number one” letter would’ve made zero difference.

 

[studentxx8800]

Just because you get a response to an LOI, it doesn't mean anything. Every single year there's people posting on here and elsewhere saying they sent an LOI and got an essential LOI back and they don't match there.

I'm also EM and like @Tenk 's program we put all LOIs and thanks yous directly in the trash. They're pathetic.

To call people who express their gratitude and/or desire to be working alongside you pathetic is truly uncalled for and say more about you as a person than anything else. I get that you might not care for them and think they're unnecessary and that's totally fair but it doesn't take much from a well-adjusted person to express appreciation for these applicants' effort then move on and not give it a second thought instead of insulting them

 

[CidHighwind]

Would you even call EM competitive? Plenty of people with average Step 1 scores and no research (yes i know its not research heavy field but still competitive specialties are) from almost any DO program match EM every year. Maybe things have changed and im not up to date

Yeah, EM isn’t truly competitive like surgical subspecialties, Derm, and rads are. It’s more like “meet this criteria, you’ll match”. The only thing is that EM blinds LOR which play a much larger role in applications than in other fields

 

[NickNaylor]

In our program (psychiatry), these kinds of "commitments" have exactly zero value to you as an applicant and do not change anything whatsoever.

As far as the OP's situation, the most likely outcome is that it won't matter, even if you do nothing. However, I do think it's professional and appropriate to follow-up with the program and let them know that you will be ranking another program #1, even if doing so will have zero impact on your application process. It's the professional thing to do, and as others have mentioned, it will become patently obvious to the program and its staff that you did not, in fact, rank them #1 if they rank you to match and you match elsewhere. That's not a good way to get your career started.

Things like the above have happened a couple of times in our program. In one case, extensive accommodations were made to address an applicant's specific clinical interest with the expectation that the applicant would be coming to this program as they were ranked to match and indicated that they would be ranking the program #1. Match day comes and the applicant matches elsewhere and had not told the program's leadership that this is what would be occurring (and after significant legwork had been done to make arrangements to fit the applicant's interests - these changes included fundamentally changing the rotation schedule and essentially creating a "custom" scheduled tailored to this applicant's interests). Congratulations, you have now entirely burned your bridges at this program, and it is very unlikely that they will get a job here unless there's a significant shake-up in the department leadership.

 

[slowthai]

Nobody cares. Just don’t send out another one. Rank them however you want. To make you feel better, these don’t matter. I was in my PDs office one day during interview season and he was like look at this crap. He turned his computer and it’s just email spam from applicants. He just deleted them all.

I can't wait to be a PD and delete all these love letters from applicants loooool

 

[d0cintheb0x]

In our program (psychiatry), these kinds of "commitments" have exactly zero value to you as an applicant and do not change anything whatsoever.

As far as the OP's situation, the most likely outcome is that it won't matter, even if you do nothing. However, I do think it's professional and appropriate to follow-up with the program and let them know that you will be ranking another program #1, even if doing so will have zero impact on your application process. It's the professional thing to do, and as others have mentioned, it will become patently obvious to the program and its staff that you did not, in fact, rank them #1 if they rank you to match and you match elsewhere. That's not a good way to get your career started.

Things like the above have happened a couple of times in our program. In one case, extensive accommodations were made to address an applicant's specific clinical interest with the expectation that the applicant would be coming to this program as they were ranked to match and indicated that they would be ranking the program #1. Match day comes and the applicant matches elsewhere and had not told the program's leadership that this is what would be occurring (and after significant legwork had been done to make arrangements to fit the applicant's interests - these changes included fundamentally changing the rotation schedule and essentially creating a "custom" scheduled tailored to this applicant's interests). Congratulations, you have now entirely burned your bridges at this program, and it is very unlikely that they will get a job here unless there's a significant shake-up in the department leadership.

yea. after I sent that initial email, he replied essentially "we would love to have you on our team" (I know this essentially doesn't mean much) but I feel like I'm really being recruited hard by some of the docs at the institution due to the fact that I don't think they fill each year (I really think they will rank me to match). I don't want to burn a bridge for sure, but I don't want to send a "hey I'm not ranking you #1 afterall lolz" email. I think I'm leaning towards being silent towards that program, but sending a #1 email to my actual #1. thoughts?

 

[Mass Effect]

In our program (psychiatry), these kinds of "commitments" have exactly zero value to you as an applicant and do not change anything whatsoever.

As far as the OP's situation, the most likely outcome is that it won't matter, even if you do nothing. However, I do think it's professional and appropriate to follow-up with the program and let them know that you will be ranking another program #1, even if doing so will have zero impact on your application process. It's the professional thing to do, and as others have mentioned, it will become patently obvious to the program and its staff that you did not, in fact, rank them #1 if they rank you to match and you match elsewhere. That's not a good way to get your career started.

Things like the above have happened a couple of times in our program. In one case, extensive accommodations were made to address an applicant's specific clinical interest with the expectation that the applicant would be coming to this program as they were ranked to match and indicated that they would be ranking the program #1. Match day comes and the applicant matches elsewhere and had not told the program's leadership that this is what would be occurring (and after significant legwork had been done to make arrangements to fit the applicant's interests - these changes included fundamentally changing the rotation schedule and essentially creating a "custom" scheduled tailored to this applicant's interests). Congratulations, you have now entirely burned your bridges at this program, and it is very unlikely that they will get a job here unless there's a significant shake-up in the department leadership.

Ditto. And I'm just thinking about what the PD and others will say when you send the follow up to say you're choosing another program as your #1. They may be disappointed, but they get it. The PD was exactly where the OP was once upon a time. But imagine how they'll remember the OP -- "that guy (or gal) had the class to let us know the truth instead of blowing smoke." OP, if you do end up matching there, it won't hurt you. And if you don't match there, it'll actually help you to give them a heads up.

 

[Wordead]

Our rank list (ENT) is made the day you interview. Not much moves the meter unless your well connected ENT attending makes a call and really lobbies for you personally

 

[CherryRedDracul]

Our rank list (ENT) is made the day you interview. Not much moves the meter unless your well connected ENT attending makes a call and really lobbies for you personally

Same at my radiology program. We're figuring out where to fit you into the rank order list right before lunch.

Things might be different at different programs, but I can imagine that the post-interview communication will rarely change anything for the reasons Tenk stated above. It's all Kabuki theater. Rank programs based on what you like and want. Expect every program trying to court you to be lying to you.

Because I know programs tried to sweep their problems under the dust or at least downplay them.