Rank Order List Questions!

[pazu]

Hope everyone is on the home stretch of their interview trail! I figure it's about time to start a thread about ROL. I have a question about the ROL that has remained unanswered even though I've asked numerous residents about this.

I'm matching into neurology, and there are a few advanced programs on my list that will require a separate prelim ROL. I would really like to do my prelim year in the same city as my neuro residency. If I match into neuro but do not match prelim, that would be my worst nightmare. So, is there any way to specify on my rank list to drop down to my next neurology choice if I didn't match any of my prelim choices? I heard there was, but no one has been able to clarify this.

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[MrBurns10]

I don't believe so. My understanding is that you will match to the highest primary spot on your list, regardless of your secondary match.

 

[lapooh]

Hi Pazu

Pazu, unfortunately Burns10 is right. My SO was in the Radiology match in 2008 and strongly felt that there should atleast be an option (user selectable checkbox, not mandatory) to drop to a complete match (ie a categorical program) if a higher ranked advanced program results in a partial match without a PGY-1 position.

My SO who matched Radiology 2y back had a mix of categorical and advanced programs(with supplementary lists of PGY-1 spots), and definitely didn't want to scramble even for a PGY-1. Luckily he matched, but after the match he strongly suggested to the NRMP that this option should be available.

Their reply was typically bureaucratic, putting the onus on programs:

"Thank you for your suggestion; however, the NRMP has no plans to change
its matching algorithm in the manner you suggest. It is possible for
programs to create a joint advanced-preliminary set-up so that
applicants who match to the advanced program are assured positions in
the preliminary program if they rank it, but not all programs choose
that option."

Hopefully if more people write to the NRMP, the may change their policy, at least for subsequent years. I think it is unfair that someone who could deservedly be completely matched into a lower ranked categorical program should be left hanging dry for a scramble.

 

[NotAProgDirector]

Hopefully if more people write to the NRMP, the may change their policy, at least for subsequent years. I think it is unfair that someone who could deservedly be completely matched into a lower ranked categorical program should be left hanging dry for a scramble.

Although it sounds like this would be easy and help people, it's actually much more complex than you would think.

One solution is this: have a "rank code" for "Skip to the next categorical match" that you can list on your prelim ROL's. This would allow you to selectively choose what to do when you reach the end of a prelim ROL (after tentatively matching into a rads spot) -- i.e. choosing to skip to your next advanced match, or keep what you've got and scramble for a prelim.

Seems straightforward, right?

Two big problems:

1. The first is recognizing that you could lose everything this way. If you chose to drop an advanced match because you failed to match prelim and try to match at your next spot, there is some chance that you would not match at any more advanced spots (or, alternatively, would not match at any prelim spots). hence, you could end up with only a prelim, or nothing at all, when you could have had a radiology spot. From the NRMP's perspective, just as many people could be upset by that outcome as are upset by the current problems.

You could argue that people have the choice (i.e. to try to skip to their next or keep what they have) but some number of people will "screw it up", and the more complicated it is the more will screw it up.

2. The more concerning problem is the way the match algorithm works. Warning, geeky explanation follows. The match is currently run as two separate matches. First, the advanced/categorical match is run and finalized -- those rank lists are fixed and don't change. Then, the prelim match is run -- for those that matched advanced the appropriate prelim list is used, again the match lists don't change during the match. This makes the match algorithm linear -- it always gets the same answer in a reasonable amount of time no matter what order it is run in. By "order", the algorithm has to take applicants one at a time and try to match them into programs. No matter what order the applicants are processed, you get the same answer -- it doesn't matter whether your match is first or last.

If we try to do what you are suggesting, then the Cat/Adv and Prelim matches need to run simultaneously, and the prelim ROL's will change as the Cat/Adv match is processed. This leads to a non-linear problem -- one that might have several different answers depending on how it is run.

An example may help: Let's say you are trying to match to Rads and Prelim. The way the match is currently run, rads goes first. The match trys to put you in your first rank, but all those spots are full with people who are higher on that programs ROL than you, so you're out of luck. So, the match puts you in your second rank. As the match progresses, there is NO CHANCE that a spot will open up at your first rank. Some people may get bumped out by others higher on the programs rank list, but never by someone lower.

If we try to run the Adv/Cat and Prelim matches together, this falls apart. Same scenario. The match tries to put you in your #1, but all spots are full, so on to your #2. But, then later in the match some applicant who has matched to your #1 gets bumped out of all of their prelims, has chosen this "skip" option, and moves down their list leaving a spot open. How would we decide whom would get this spot? It would require going "backwards" in the match algorithm -- relooking at whether you could match there. If you do, then that opens a spot at your #2 which generates the same problem.

This creates a circular/recursive/non linear problem that is much, much harder to solve. This doesn't mean that it's impossible to solve, but it does mean that there may be several possible answers depending on where you start. These answers would only be a tiny bit different (likely 99% of people would end up exactly the same) but it could create all sorts of problems for the NRMP.

So, this is probably not going to happen, no matter how many people write. Feel free to try, though.

 

[coup de chance]

per NRMP's 2010-2011 user guide PDF:

Matches are tentative because an applicant who is matched to a program at one point in the matching process may be removed from the program at some later point to make space for an applicant more preferred by the program, as described in the second case above. When an applicant is removed from a previously made tentative match, an attempt is made to re-match this applicant, starting from the top of his/her list. This process is carried outfor all applicants, until each applicant has either been tentatively matched to the most preferred choice possible or all choices submitted by the applicant have been exhausted. When all applicants have been considered, the match is complete and all tentative matches become final.

Thus there would not be the question of where to assign the newly empty spot (made empty by the top-ranked candidate going elsewhere).

Although it sounds like this would be easy and help people, it's actually much more complex than you would think.

One solution is this: have a "rank code" for "Skip to the next categorical match" that you can list on your prelim ROL's. This would allow you to selectively choose what to do when you reach the end of a prelim ROL (after tentatively matching into a rads spot) -- i.e. choosing to skip to your next advanced match, or keep what you've got and scramble for a prelim.

Seems straightforward, right?

Two big problems:

1. The first is recognizing that you could lose everything this way. If you chose to drop an advanced match because you failed to match prelim and try to match at your next spot, there is some chance that you would not match at any more advanced spots (or, alternatively, would not match at any prelim spots). hence, you could end up with only a prelim, or nothing at all, when you could have had a radiology spot. From the NRMP's perspective, just as many people could be upset by that outcome as are upset by the current problems.

You could argue that people have the choice (i.e. to try to skip to their next or keep what they have) but some number of people will "screw it up", and the more complicated it is the more will screw it up.

2. The more concerning problem is the way the match algorithm works. Warning, geeky explanation follows. The match is currently run as two separate matches. First, the advanced/categorical match is run and finalized -- those rank lists are fixed and don't change. Then, the prelim match is run -- for those that matched advanced the appropriate prelim list is used, again the match lists don't change during the match. This makes the match algorithm linear -- it always gets the same answer in a reasonable amount of time no matter what order it is run in. By "order", the algorithm has to take applicants one at a time and try to match them into programs. No matter what order the applicants are processed, you get the same answer -- it doesn't matter whether your match is first or last.

If we try to do what you are suggesting, then the Cat/Adv and Prelim matches need to run simultaneously, and the prelim ROL's will change as the Cat/Adv match is processed. This leads to a non-linear problem -- one that might have several different answers depending on how it is run.

An example may help: Let's say you are trying to match to Rads and Prelim. The way the match is currently run, rads goes first. The match trys to put you in your first rank, but all those spots are full with people who are higher on that programs ROL than you, so you're out of luck. So, the match puts you in your second rank. As the match progresses, there is NO CHANCE that a spot will open up at your first rank. Some people may get bumped out by others higher on the programs rank list, but never by someone lower.

If we try to run the Adv/Cat and Prelim matches together, this falls apart. Same scenario. The match tries to put you in your #1, but all spots are full, so on to your #2. But, then later in the match some applicant who has matched to your #1 gets bumped out of all of their prelims, has chosen this "skip" option, and moves down their list leaving a spot open. How would we decide whom would get this spot? It would require going "backwards" in the match algorithm -- relooking at whether you could match there. If you do, then that opens a spot at your #2 which generates the same problem.

This creates a circular/recursive/non linear problem that is much, much harder to solve. This doesn't mean that it's impossible to solve, but it does mean that there may be several possible answers depending on where you start. These answers would only be a tiny bit different (likely 99% of people would end up exactly the same) but it could create all sorts of problems for the NRMP.

So, this is probably not going to happen, no matter how many people write. Feel free to try, though.

 

[hot sauce]

per NRMP's 2010-2011 user guide PDF:

Matches are tentative because an applicant who is matched to a program at one point in the matching process may be removed from the program at some later point to make space for an applicant more preferred by the program, as described in the second case above. When an applicant is removed from a previously made tentative match, an attempt is made to re-match this applicant, starting from the top of his/her list. This process is carried outfor all applicants, until each applicant has either been tentatively matched to the most preferred choice possible or all choices submitted by the applicant have been exhausted. When all applicants have been considered, the match is complete and all tentative matches become final.

Thus there would not be the question of where to assign the newly empty spot (made empty by the top-ranked candidate going elsewhere).

You aren't grasping the concept and the implications with two matches going on. Feel free to write to the NRMP though because posting here isn't going to change how it's run.

 

[future06]

I applied to FM and IM. Now it is time to rank.

On this forum I read a thread from 2010 or 2011 that if I mix specialties it won't affect me (only NRMP statistics).

But our Kaplan director told us that it is better to rank one specialty and than another one. Like that:
1.FM
2.FM
3.IM
4.IM
5.IM
He said that algorithm "won't understand my ROL and it is may affect me" or something like that, if I will mix specialties. Although I trust his opinion, he is not a physician. Could anybody who is PD, attending or resident advise me, please?

In reality I want to place IM program #3 to # 2, but than I will mix specialties, b/c #2FM will step down to # 3.
Thank you in advance.

 

[gutonc]

I applied to FM and IM. Now it is time to rank.

On this forum I read a thread from 2010 or 2011 that if I mix specialties it won't affect me (only NRMP statistics).

But our Kaplan director told us that it is better to rank one specialty and than another one. Like that:
1.FM
2.FM
3.IM
4.IM
5.IM
He said that algorithm "won't understand my ROL and it is may affect me" or something like that, if I will mix specialties. Although I trust his opinion, he is not a physician. Could anybody who is PD, attending or resident advise me, please?

In reality I want to place IM program #3 to # 2, but than I will mix specialties, b/c #2FM will step down to # 3.
Thank you in advance.

Anybody who understands the Match algorithm can advise you...your "Kaplan director" does not appear to be one of those people.

The algorithm is specialty agnostic. It takes into account the rank lists of USERID:ABCD12345 and PROGRAMID:98765WXYZ which, while obviously linked to specific people and specialty programs, are irrelevant for the purposes of the algorithm.

RTHYLT

 

[future06]

Gutonc, so I can safely make my ROL in the "mixing way" FM, IM, FM, IM, IM? I mean that computer WILL understand what I want and will match me PROPERLY, right?

I understand algorithm and read about it, that we have to make our ROL based on our preferences...I am not arguing that or ask anybody to ellaborate on this topic-it is clear to me.
I was just worried about mixing specialties...sorry if I sound redundant.

 

[FlowLimited]

Gutonc, so I can safely make my ROL in the "mixing way" FM, IM, FM, IM, IM? I mean that computer WILL understand what I want and will match me PROPERLY, right?

I understand algorithm and read about it, that we have to make our ROL based on our preferences...I am not arguing that or ask anybody to ellaborate on this topic-it is clear to me.
I was just worried about mixing specialties...sorry if I sound redundant.

Yes. The computer runs down your list until it can make a match regardless of the type of program.

 

[future06]

Gutonc and Saqrfaraj, thank you SO much for your help! Now I got it!

 

[gutonc]

Gutonc, so I can safely make my ROL in the "mixing way" FM, IM, FM, IM, IM? I mean that computer WILL understand what I want and will match me PROPERLY, right?

I understand algorithm and read about it, that we have to make our ROL based on our preferences...I am not arguing that or ask anybody to ellaborate on this topic-it is clear to me.
I was just worried about mixing specialties...sorry if I sound redundant.

To the algorithm, neurosurgery @ Columbia and FM at Bubba's House o' Doctorfyin' look exactly the same on your rank list.

 

[Medstudentquest]

To the algorithm, neurosurgery @ Columbia and FM at Bubba's House o' Doctorfyin' look exactly the same on your rank list.

Lol @ "Bubba's House o' Doctofyin'"

Lol

 

[Dirt]

For how utterly simple the basic (i.e. categorical only) match algorithm is, there is a ridiculous amount of bad advice out there.

Rank in the order you want. That's it.

If I match into neuro but do not match prelim, that would be my worst nightmare.

Really? I would think matching into a prelim but no neuro, or nothing at all, would be a hell of a lot worse.

 

[Law2Doc]

...


Really? I would think matching into a prelim but no neuro, or nothing at all, would be a hell of a lot worse.

you are responding to a 2009 post. Hopefully he's matched by now.

 

[Dirt]

you are responding to a 2009 post. Hopefully he's matched by now.

It was kind of a rhetorical response.

 

[Nooblet]

Rank List/Matching question here...

I'm applying anesthesia, and for anesthesia most programs offer both categorical (4 yrs) and advanced positions (prelim/TY which you find yourself + 3 yrs anesthesia). Up until this point I thought I would easily be able to rank the categoricals/advanced in whatever order I wished.

For example, I wanted to do:

1. Advanced anesthesia program X + Transitional Year Y
2. Categorical anesthesia program X
3. Advanced anesthesia program X + Transitional Year Z

etc. etc.

But the ROL won't let me re-list the advanced program again saying its a duplicate. Does this mean that the categorical either must be completely before or completely after my preliminary ranks?

 

[NotAProgDirector]

Rank List/Matching question here...

I'm applying anesthesia, and for anesthesia most programs offer both categorical (4 yrs) and advanced positions (prelim/TY which you find yourself + 3 yrs anesthesia). Up until this point I thought I would easily be able to rank the categoricals/advanced in whatever order I wished.

For example, I wanted to do:

1. Advanced anesthesia program X + Transitional Year Y
2. Categorical anesthesia program X
3. Advanced anesthesia program X + Transitional Year Z

etc. etc.

But the ROL won't let me re-list the advanced program again saying its a duplicate. Does this mean that the categorical either must be completely before or completely after my preliminary ranks?

That's correct. You can only list the Cat and the Advanced once each on your list. For the advanced, you can then generate a list of prelims / TY's in any order you want. But the prelims go on a seperate rank list -- a prelim only rank list.

So, your match list will be:

1. Adavanced X
2. Categorical X

(or the other way around)

and then you'll have a seperate prelim list:

1. Prelim A
2. TY B
3. TY C
4. Prelim D

etc.

You can have a different prelim list for each Advanced program you rank (so you can readjust your match based upon geography)

 

[DrBowtie]

Rank List/Matching question here...

I'm applying anesthesia, and for anesthesia most programs offer both categorical (4 yrs) and advanced positions (prelim/TY which you find yourself + 3 yrs anesthesia). Up until this point I thought I would easily be able to rank the categoricals/advanced in whatever order I wished.

For example, I wanted to do:

1. Advanced anesthesia program X + Transitional Year Y
2. Categorical anesthesia program X
3. Advanced anesthesia program X + Transitional Year Z

etc. etc.

But the ROL won't let me re-list the advanced program again saying its a duplicate. Does this mean that the categorical either must be completely before or completely after my preliminary ranks?

Yeah, there is no way around this best I can tell. It's unfortunate as I'd much prefer the TY in the same city to the categorical program, but I'd prefer the categorical program over a TY in another city.

I'm surprised they don't do this as I'm sure they would generate more money from ranking >20 places.

 

[NotAProgDirector]

Yeah, there is no way around this best I can tell. It's unfortunate as I'd much prefer the TY in the same city to the categorical program, but I'd prefer the categorical program over a TY in another city.

I'm surprised they don't do this as I'm sure they would generate more money from ranking >20 places.

The problem is that rank lists would become ridiculously long, and easy to screw up.

Let's say you decide to rank 10 Advanced and 10 Prelim programs. Your rank list would be 120 ranks long -- 10 x 10 = 100 Advanced / Prelim combos, then 10 Advanced alone, then 10 prelim alone.

That doesn't sound too bad, until you decide to couples match with someone else applying to 10 Advanced and 10 prelim programs.

Then, the rank list would be 100 x 100 = 10,000 combinations to start (that's without the "I match and you don't" or "I get an Advanced but not a prelim", etc.

 

[hot sauce]

Yeah, there is no way around this best I can tell. It's unfortunate as I'd much prefer the TY in the same city to the categorical program, but I'd prefer the categorical program over a TY in another city.

I'm surprised they don't do this as I'm sure they would generate more money from ranking >20 places.

It also goes back to aPD's old post that the way the match is run. First the primary match list (advanced / categorical) is run and then the secondary (prelim). So under that system the computer can't match you to an advanced program dependent on you matching to a specific prelim program because it doesn't know that part of the equation yet and if it went back and forth it wouldn't work.

For example if you didn't match your desired TY so moved to a categorical program but then that opened a spot in the advanced program for someone else which then opens up a spot somewhere else and ends up moving a bunch of people around. But what if because of those changes your desired TY spot is open? Do you then get moved back into the advanced program which would then cause another shift? Even if you say no, you don't move back into the advanced program the result could be different depending on the order that people are put through the match. The current system only has one possible outcome from all the lists regardless of the order it is run.

 

[snoggy6]

2. The more concerning problem is the way the match algorithm works. Warning, geeky explanation follows. The match is currently run as two separate matches. First, the advanced/categorical match is run and finalized -- those rank lists are fixed and don't change. Then, the prelim match is run -- for those that matched advanced the appropriate prelim list is used, again the match lists don't change during the match. This makes the match algorithm linear -- it always gets the same answer in a reasonable amount of time no matter what order it is run in. By "order", the algorithm has to take applicants one at a time and try to match them into programs. No matter what order the applicants are processed, you get the same answer -- it doesn't matter whether your match is first or last.

If we try to do what you are suggesting, then the Cat/Adv and Prelim matches need to run simultaneously, and the prelim ROL's will change as the Cat/Adv match is processed. This leads to a non-linear problem -- one that might have several different answers depending on how it is run.

Apologies for quoting an old post, but there is something here that I don't quite understand...

An applicant is allowed to rank both advanced and preliminary programs on their primary ROL. If the match is run as you describe (two separate matches, first advanced/categorical, then prelim after the first is finalized), how is it handled when prelims are mixed with advanced on the primary ROL? Assume I make a ROL like this (I admit this would be stupid, but for just for example):
1. Advanced program
2. Prelim program
3. Advanced program
If I don't match to #1, then it has to go to my #2, but according to your explanation, most people (those who match to an advanced program) won't be matching into a prelim program yet since that is run as a second match after the advanced match is done. So let's say there's a spot open in my #2 and once everyone has matched into their primary ROL spot, I'm still sitting in my #2 because I haven't been bumped out. Now the "prelim match" is run for all the people who matched to an advanced spot, and I get bumped out of that prelim program because the program prefers someone else over me. What happens then? Wouldn't the match algorithm have to move to my #3, which is an advanced position? And then couldn't I bump out someone else who had already matched there, and screw up the whole thing?

Maybe the algorithm has changed since this post was written, but I found something on the NRMP website that seems to contradict this post:
"A supplemental rank order list will be used in the Match only if the applicant matches to an advanced program on the primary rank order list. The supplemental rank order list is used as part of the Main Match and is not a separate match. During the matching process, the matching algorithm first looks at an applicant's primary rank order list and attempts to make a match. If the applicant is matched to an advanced program, the algorithm will seek to match the applicant to a preliminary position from the supplemental rank order list that is linked to that advanced program. If the algorithm is unable to match the applicant to a first-year program, the match to the advanced program still holds, and the applicant will have to seek a PGY-1 position after the Match."

 

[NotAProgDirector]

Apologies for quoting an old post, but there is something here that I don't quite understand...

An applicant is allowed to rank both advanced and preliminary programs on their primary ROL. If the match is run as you describe (two separate matches, first advanced/categorical, then prelim after the first is finalized), how is it handled when prelims are mixed with advanced on the primary ROL? Assume I make a ROL like this (I admit this would be stupid, but for just for example):
1. Advanced program
2. Prelim program
3. Advanced program
If I don't match to #1, then it has to go to my #2, but according to your explanation, most people (those who match to an advanced program) won't be matching into a prelim program yet since that is run as a second match after the advanced match is done. So let's say there's a spot open in my #2 and once everyone has matched into their primary ROL spot, I'm still sitting in my #2 because I haven't been bumped out. Now the "prelim match" is run for all the people who matched to an advanced spot, and I get bumped out of that prelim program because the program prefers someone else over me. What happens then? Wouldn't the match algorithm have to move to my #3, which is an advanced position? And then couldn't I bump out someone else who had already matched there, and screw up the whole thing?

Maybe the algorithm has changed since this post was written, but I found something on the NRMP website that seems to contradict this post:
"A supplemental rank order list will be used in the Match only if the applicant matches to an advanced program on the primary rank order list. The supplemental rank order list is used as part of the Main Match and is not a separate match. During the matching process, the matching algorithm first looks at an applicant's primary rank order list and attempts to make a match. If the applicant is matched to an advanced program, the algorithm will seek to match the applicant to a preliminary position from the supplemental rank order list that is linked to that advanced program. If the algorithm is unable to match the applicant to a first-year program, the match to the advanced program still holds, and the applicant will have to seek a PGY-1 position after the Match."

I cringed when I read what I had written before, since it really can't be correct. Thanks for keeping me honest.

As the above post makes clear, it's all one match. The algorithm works down your main match list, and each time it finds a "temporary fit" it then picks the associated prelim match list (if any) and works on a prelim match also. Then, if you later get bumped out of your temporary fit on your main match, it pulls you out of the prelim match also and continues down your rank list, trying to match you to both lists.

This does make the prelim match part of the algorithm more complicated. In the main match, you can only get bumped out if someone who is ranked higher on the program's list matches there. Therefore, when trying to match you to your #1 rank, if the program is full with people who were ranked higher than you, then you can'tpossibly match there. No matter what happens as the match progresses, the program will always be full with people ranked above you.

For prelim lists, that's not the case. A program might be full of people ranked higher than you when your list is processed. However, as the match progresses one of those people might lose their advanced spot, and therefore "give up" their prelim spot (i.e. rank some other prelim higher on a different prelim rank list when their advanced match changes).

One way to "fix" this is to run the advanced match first, and then the prelim match. But, as pointed out above, that's crazy and won't work because anyone can rank a prelim program on their main match list.

So, the way the NRMP probably addresses this is that when someone "gives up" a prelim spot because of a change in their advanced match, the algorithm could run down the program's list of higher ranked prelim candidates to see if any of them ranked the program above their current tentative matches, and if so switch them -- which then cascades, as there is now an open slot in that program, etc.

Sorry for the confusion -- both the wrong post in the past, and now this horrificly confusing mess of a post that tries to correct it.

Regardless, the net result is the same: you cannot make your advanced match dependent upon your prelim match, like Nooblet wanted.