Ranking in good faith?

[Abram Hoffer]

So as far as I understand, the Match works well.

I don't necessarily buy it.

"You don't have to buy it, pal. Just believe me when I tell you that it works."

You mean to tell me that it's life in a vacuum? I look at websites, pick the programs, pay my fees... then the interviews come. I spend tons of money to travel all over God's green (well, brown now in most places), and then, on the 3rd magical Thursday in March, my computer tells me all I need to know?

There's no "gaming" the system.

Pick your ranks for all the right reasons, not to try to influence the stars. How can this be? Life doesn't work that way. There are hints and clues to everything we do.

I know there is "sway", but I haven't seen much of this. The interviews I have been on walk very far from the line of ERAS violations. No clues, no show of any of their cards. They might be interested in some of what I have to say, but so is the average colleague who likes to hear your enthusiasm for virtually anything medicine-related.

Dating services rarely work. Why would the Residency Match be any different? At this point, I would rather each program run their own "Match", picking the candidates they like best.

So, to all of you who have matched (or not matched, for that matter), does the Match work? If so, why?

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[Law2Doc]

Dating services rarely work. Why would the Residency Match be any different? At this point, I would rather each program run their own "Match", picking the candidates they like best.

Of course the match works. It's not a complicated algorithm. You apply to where you want. Of the interviews you get, you rank where you want to end up. Programs rank the applicants they saw in the order they want them. And then a computer tries to give everybody their highest choice that also wanted them. Simple really. And no gamesmanship or dodging the rules required. You get to go to the place you liked best that liked you best.

I don't see any reason why you'd want a different system, and having each program do their own match would just end up like med school applications -- a good handful of folks with multiple matches and a good handful with few to none, and then having to resort to waitlists when a school's top choices went elsewhere. In other words, a very bad system that results in some folks only finding out where they will be attending by the week of orientation. This is a really bad system, which is the reason the Texas schools opted to do a match system rather than the exercise in futility all the other adcoms currently use. So you'd never want to extrapolate that out to residency.

I suspect a match would TOTALLY work in a dating service -- if you went out with a bunch of folks and then ranked the ones you would want a second date with and they did likewise, and then everyone ends up matched with the person they liked most who also liked them too. It's very time/labor/computer intensive so nobody would want to pay so much for something so trivial, but I have little doubt it would statistically do better than your odds of picking out the right person at a bar, party, church, etc.

 

[dragonfly99]

hoffer,
I do think that the match works in general to the applicants' advantage. This is more true in the less competitive specialties and/or ones that have a lot of positions, and where programs are less likely to apply any kind of pressure to applicants or subvert the Match. The Match is actually structured to favor what you, the applicant, wants, vs. what the hospitals want. However, for the more competitive specialties and fellowships, there are more situations where the programs/hospitals try and subvert the match (by implying or telling you that you'll get ranked higher if you rank them higher). Also, for some specialties @some hospitals/programs it really helps to be well connected (i.e. you know attendings who know people) and so the Match is not such a "double blind" situation in all cases. Sometimes program directors will call up attendings they know @other places to try and find out about applicants. But that's just kind of part of life, and things that you have to deal with in life. I think that overall the Match helps out most applicants as opposed to a system where hospitals just do regular job-type interviews and pick who they want...for folks who really only want a particular program in one particular city, I'm not sure the Match is better...if you are married with two kids and just don't want to move and just want to know where you are going to be doing residency ASAP, the Match probably isn't so great. For the typical applicant, it tends to work well to maximize his/her chances of going to the desired residency.

 

[PeepshowJohnny]

What don't you have faith in, the algorithm or the people itself?

The way the algorithm works, does in fact, boil down to "The system works best when everybody just ranks in order of preference". If you want a long and complicated situation, the NRMP publishes the way it works here: http://www.nrmp.org/res_match/about_res/algorithms.html There are several examples that show why attempts to "game" the system (ranking places you're more likely to match over those you like better, only ranking a few places) simply do not work, both from the PD and the student side. It also gives good examples about how it favors the applicant.

Put simply, it's a pretty damn simple algorithm. Note, it's not a "dating" site or anything like that. It doesn't say "Well, Applicant A likes Cardiology and Renal...hey, hospital H has great programs in them, let's put him there". All the intangibles and selections come from YOU and the PROGRAM when you make your lists, the match just takes all those lists and makes the most people happy. If you find out you hate where you end up, it's not the matches fault, it's you and the PD's for listing eachother that way.

Now, if it comes to the people, I agree there should always be skepticism. There ARE attempts to trick the system (finding where applicants are ranking the program and adjusting list to reflect that) but those are violations and can lead to pretty serious complications. Even if the NRMP doesn't find out, students talk and tend to avoid places that are known match violators.

 

[logistic]

IF...
I get any of my top 7 programs: I "performed" well on interviews.
I get programs 8-10: I didn't write enough thank you notes.
>= 11: The match is a scam...And I know that the top programs' spots are filled with people who have connections.

 

[sandraf]

IF...
I get any of my top 7 programs: I "performed" well on interviews.
I get programs 8-10: I didn't write enough thank you notes.
>= 11: The match is a scam...And I know that the top programs' spots are filled with people who have connections.

 

[jonb12997]

IF...
I get any of my top 7 programs: I "performed" well on interviews.
I get programs 8-10: I didn't write enough thank you notes.
>= 11: The match is a scam...And I know that the top programs' spots are filled with people who have connections.

nice, that's my attitude over the next 2 months...

 

[soulofmpatel]

I don't trust the match either.

I get that feeling that people who are better politicians than me will take the prime spots.

But then again...I'm just bitter because I'm a lousy politician.

 

[Old_Mil]

There's no "gaming" the system.

Pick your ranks for all the right reasons, not to try to influence the stars. How can this be? Life doesn't work that way. There are hints and clues to everything we do.

So, if all other things are equal...using the rationale that "I'd rather be at a place that likes me as much as I like them"...is evaluation of post interview feedback a valid variable to include in ranking?

 

[elr1983]

I don't trust the match either.

I get that feeling that people who are better politicians than me will take the prime spots.

But then again...I'm just bitter because I'm a lousy politician.

I agree. I'm a lousy politician, too, and refuse to do things like ask someone to make phone calls on my behalf. I worked hard, got good grades and good step scores, and would like to think that's enough to match well. However, I think it's going to be the people who know someone or have people call on their behalf, etc, that are going to take the top spots.

 

[Law2Doc]

So, if all other things are equal...using the rationale that "I'd rather be at a place that likes me as much as I like them"...is evaluation of post interview feedback a valid variable to include in ranking?

I wouldn't put too much weight on it because all programs are going to put on a good face and make you think they are interested in you -- they haven't started evaluating you against others at that point and it is to their advantage to keep everybody excited about them until they actually decide who they are going to rank. So I wouldn't but too much weight on which PD does a better job of saying "I enjoyed meeting you and hope you'll come back for a second look". However if you did an away rotation where you got substantial exposure and good feedback, that I might put high on your criteria.

 

[MedObsession]

I wouldn't put too much weight on it because all programs are going to put on a good face and make you think they are interested in you -- they haven't started evaluating you against others at that point and it is to their advantage to keep everybody excited about them until they actually decide who they are going to rank. So I wouldn't but too much weight on which PD does a better job of saying "I enjoyed meeting you and hope you'll come back for a second look". However if you did an away rotation where you got substantial exposure and good feedback, that I might put high on your criteria.

I'm not convinced that they "haven't started evaluating you against others at that point." They have been evaluating us against others since we submitted that ERAS application. That is how they decide who they want to interview and those that they don't. I have talked to people that interviewed with the program director on the same exact day and some people will leave with the PD telling them that they think the applicant will be a great fit and how much they like them, and another applicant commenting that they had a tough interview with tough questions from the PD. I don't think that they necessarily tell people they don't like them since that would be a poor recruitment move, but they are definitely very vocal if they really do like you.

Several programs that I went to told us not to send correspondence because they have a meeting right after each interview day where they give us all a score and put us in a ranking order. Then after all the interview days they compile the scores into the final list. Most of the programs that I interviewed at had their last interview days in late Dec/early January. I think it is naive to think that we aren't being compared to everyone else that is interviewing until they submit that final list.

 

[Law2Doc]

I'm not convinced that they "haven't started evaluating you against others at that point." They have been evaluating us against others since we submitted that ERAS application. That is how they decide who they want to interview and those that they don't. I have talked to people that interviewed with the program director on the same exact day and some people will leave with the PD telling them that they think the applicant will be a great fit and how much they like them, and another applicant commenting that they had a tough interview with tough questions from the PD. I don't think that they necessarily tell people they don't like them since that would be a poor recruitment move, but they are definitely very vocal if they really do like you.

Several programs that I went to told us not to send correspondence because they have a meeting right after each interview day where they give us all a score and put us in a ranking order. Then after all the interview days they compile the scores into the final list. Most of the programs that I interviewed at had their last interview days in late Dec/early January. I think it is naive to think that we aren't being compared to everyone else that is interviewing until they submit that final list.

Well, you are roughly being compared, but until all the applicants get seen, they aren't going to give away spots on their rank list with any credibility. It's not inconceivable that the last weeks of interviewees end up being the best -- they aren't scheduled based on preference. So if you interviewed in December and they gave you great feedback, but they keep interviewing through January, you may not even be in the picture by the time they enter their final list. So sure, they keep a running tally as to who they like and how much, but there's no commitment, and no way to know if you don't get blown out of the water by a bigger gun the next week. Which is why you take everything with a grain of salt and don't rely on any of it.