Programs interested in how YOU rank them

The rules are that neither you nor the program can lie to each other, the program cannot make a commitment to you prior to the match, and they cannot compel you to tell them where you are going to rank them. Programs like to be able to brag that they didn't have to go far down their match list, or that everyone who comes really wanted to come. Probably makes for happier residents if everyone wanted to be there. Because you aren't supposed to lie to programs in your communications under the NRMP rules, it would be unadvisable to tell multiple programs that they are #1. But nothing wrong with telling multiple programs that they are high on your list or other similarly vague statements.

 

I have been asked this point-blank twice during interviews so far. It's not really a fair question, especially when interviews are not yet over.

 

I haven't been asked stuff like it ("are we your number one?") since my first interview, fortunately.

 

<Some PDs/ interviewers have told me that letting them know they are at the top of my list come Feb. is important as that will somehow alter their decision? >
Yes sometimes it affects how they rank you.

<It has been stressed before that letting a program know they are being ranked highly by the applicant is an important move. How does this work and why do they care? >
How it works is you can write or call them to tell them they are being ranked highly, and/or get a faculty member who knows someone @the other program to call and put the good word in for you, and tell them you are ranking them highly

<Can't they just go further down the list without that knowledge?>
They could and this is what they SHOULD do, and the whole point of the Match was to try to avoid one side of the other being able to exert pressure. However, many programs have an ego thing about not wanting to go very far down their list. Yes, it is VERY stupid, IMHO. Nevertheless, programs that feel like this will do what they can to find out how you plan to rank them, and won't have much compunction about bending the rules as much as necessary to do that.

< It feels that we really have one shot to pick a top program, let them know they are #1 and hope that we get ranked to match. Any insight?>
Not true for noncompetitive specialties like IM, especially if the program needs to match maybe 30 people. May be more true for more competitive specialties. That's why applicants sometimes strategically pick one or two places they'd like to go to, and have a decent shot at getting in to, and then lobby to get in there (i.e. write letter telling them you're ranking them #1 or very high, get faculty to call to put in a good word for you, etc.).

<Do people tell multiple programs they are #1 in that case to minimize risk of not getting a top pick?>
Yes. Generally nothing would happen to you if you did this, although I wouldn't go tell 10 programs this.

 

In a slight defense of programs who use this tactic...all things being equal, I'd rather match with someone who at least appears excited about the prospect of coming to my program. That's where personality can slightly outweigh academics during the final rank meeting.

Residency is hard. Matching with someone predisposed to a positive attitude can make for a stronger program with happier residents.

 

Of course it is important that a resident has a positive attitude and is planning to come there and work hard, and is committed to the program. I'm not sure that you can judge that well in an interview - some applicants are extremely good at laying it on thick and/or are just more outgoing, but that doesn't necessarily translate into someone with "a better attitude" during training. And I don't think there is a good excuse for programs to try to pressure applicants into ranking them higher because the applicants fear it is the only way they can match.

The Match was created in part to try to keep programs from being able to do those types of things, but some programs persist in trying to subvert the system. One can argue where the line is (in terms of what it is permissible for programs to say or ask) but I think that there is no doubt that some programs knowingly cross the line and use scare tactics in order to try to do better in the Match. IMHO when I interviewed for fellowship, it was the weaker and/or middle tier programs that did this...and while I understood why programs would do this I still think it is unethical to try to scare/pressure med students or residents into tipping their hand as to how they plan to rank programs. Just sell your program and if you do your job and it is a good program, you will match good residents into your program.

 

My problem exactly...I definitely want to tell my #1 that they are in fact my #1. I also want to only tell one program that they are my #1. Thus I am compelled to make sure that my #1 is in fact a program at which I have a reasonable chance of matching. If I follow this train of thought - I definitely will not be using the match process "to its max advantage." I will be instead trying to guess who wants me in their program. And of course, because of the system in place, I would only be GUESSING!

It complicates it even more when the program encourages a "second look." I think to myself, "...great, now if I want them to take me seriously, I not only have to tell them that they are my #1, I have to spend more money to come back here and kiss up even more...cause Lord knows, if I don't come back for a second look - there sure as hell will be somebody else who does. Then I am at a disadvantage to that guy as well."

 

Ahh yes, the second look.. It is costing me a good bit of money. I actually went back to one program for a whole week and to 2 others for 1 day each.

The week long place traditionally takes a person that has rotated there. During the interview the program director said they liked me but that it was hard to make a decision based on just 24 hours. He said if I was interested that I could consider it, and I did.

Another place... One director said he liked me and he would offer me a contract right then if he could, but not allowed to. Then asked if I would like to come back and I accepted.

Last place.. At the end of the interview said he wanted me to be in contact when my interviews were done, so we could talk about where we were ranking each other. To me, this is a fairly good sign. I sent an email and asked about coming back. He said during the interview they thought favoralby about me and that coming back would be a great idea.

I would be happy at any of these 3 program. So I have invested my time and money in doing this. I have other programs that I liked, but the positive vibe just wasn't there like these places.

 

Where did you find time to go back and spend a week at a program? And what did you do for an entire week?

 

This month (december) was my vacation month, I went on my own free time just as an "observer" outside of my school. When I went there I met with the residents in the morning, did rounds (no charting), got pimped, went to the OR but unfortunately was only able to watch.

Apparently this program interviewed about 30 applicants for 1 or 2 positions. One of the interns said they knew the staff thought very highly of the fact that I showed enough interest in their program to do this.

 

For the other 2 programs... I did cancel one interview in NY, at a program I was less interested in, in order to spend 2 days doing the second looks. I fly into Chicago, do a dinner and an interview, then a second look at a different program in Chicago, then a second look in St. Louis the next day. Luckily both programs were alright with the dates I proposed. If they wouldn't have accepted the dates I wouldn't have been able to do the second look. Was able to knock out 3 things with one round trip ticket and a rental car. Spending too much money on all of this..