SOAP 2015 thread making me nervous

[drdang92]

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Does the SOAP 2015 thread make anyone else a bit nervous about starting med school? Is this normal? It's scary to witness how many quality applicants go unmatched, since I had no idea how prevalent this was. There was a girl on there who attended a top 20 program who is struggling to find an FM spot after 3 years!

Link to post here:
http://www.forums.studentdoctor.net/index.php?threads/SOAP-2015.1125858/

 

[NickNaylor]

The majority of applicants don't have to SOAP. Those that do are typically either weak applicants for their given field, can't make it through an interview, or didn't rank enough programs.

Posts in those threads never reveal the true story. There is always another side to the coin exactly as there is in medical admissions. Be weary of the person that makes it seem as if getting a residency position (or admitted to medical school) seem like an impossible task. Plenty of people do it every year. Situations like that are far from normal.

 

[DrBowtie]

Does the SOAP 2015 thread make anyone else a bit nervous about starting med school? Is this normal? It's scary to witness how many quality applicants go unmatched, since I had no idea how prevalent this was. There was a girl on there who attended a top 20 program who is struggling to find an FM spot after 3 years!

Link to post here:
http://www.forums.studentdoctor.net/index.php?threads/SOAP-2015.1125858/

50% of people also get their #1 spot.

Also, There is always more to people's stories than they tell.

Perform well in med school, apply smartly in terms of specialty, location and competitiveness and you'll have nothing to worry about.

 

[PL198]

The majority of applicants don't have to SOAP. Those that do are typically either weak applicants for their given field, can't make it through an interview, or didn't rank enough programs.

Posts in those threads never reveal the true story. There is always another side to the coin exactly as there is in medical admissions. Be weary of the person that makes it seem as if getting a residency position (or admitted to medical school) seem like an impossible task. Plenty of people do it every year. Situations like that are far from normal.

I feel like 99 % of people that SOAP either only apply to super competitive programs or only rank like 5 programs. It's like the people where the only colleges they apply to are the ivies. Idc if you're christ on earth, that's a foolish move, so I have no idea why people do it with residency as well.

 

[drdang92]

@NickNaylor @DrBowtie @PL198 thanks! This is very reassuring! But can someone please explain what a 'partial match' is?

 

[ridethecliche]

Isnt that a prelim year?

 

[NickNaylor]

I feel like 99 % of people that SOAP either only apply to super competitive programs or only rank like 5 programs. It's like the people where the only colleges they apply to are the ivies. Idc if you're christ on earth, that's a foolish move, so I have no idea why people do it with residency as well.

We had one woman in our class rank one program for a ROAD specialty. Unsurprisingly, she had to SOAP.

 

[caffeinemia]

50% of people also get their #1 spot.

Also, There is always more to people's stories than they tell.

Perform well in med school, apply smartly in terms of specialty, location and competitiveness and you'll have nothing to worry about.

the PERFORM WELL and APPLY SMARTLY parts are key here. Getting steps of 200 and applying to Ortho is common delusion.

@NickNaylor @DrBowtie @PL198 thanks! This is very reassuring! But can someone please explain what a 'partial match' is?

Partial match is when the organ donor and recipient have less than 6 out of 6 MHC compatibility.

Or... maybe it's when you apply to an advanced program and a prelim/transitional year and only secure a position for one of the two.

 

[sazerac]

We had one woman in our class rank one program for a ROAD specialty. Unsurprisingly, she had to SOAP.

The look on her face Monday when she opened her email must have been priceless. I hope she found another position to her satisfaction.

 

[PL198]

We had one woman in our class rank one program for a ROAD specialty. Unsurprisingly, she had to SOAP.

I'm gonna assume she had decent stats. It always perplexes me how people manage to function on a high level, yet exhibit such low intelligence

 

[NickNaylor]

@NickNaylor @DrBowtie @PL198 thanks! This is very reassuring! But can someone please explain what a 'partial match' is?

As mentioned above, a partial match occurs when you match a pre-lim/transitional year (i.e., your intern year) but not an advanced spot (i.e., your specialty-specific training) or vice versa. Some fields don't include "categorical" spots, which are spots that include all of the training under one program. In that setup, you only need to match to one program to have an intern year and advanced spot. For the fields that don't have categorical positions (or if you match to a non-categorical spot), you need to apply to a pre-lim/transitional year separately and match into that program in addition to your advanced training.

It's typically not a big deal to have a partial match that includes an advanced position but not a pre-lim/transitional year. It's more of a problem to have the opposite situation.

 

[SouthernSurgeon]

The majority of applicants don't have to SOAP. Those that do are typically either weak applicants for their given field, can't make it through an interview, or didn't rank enough programs.

Posts in those threads never reveal the true story. There is always another side to the coin exactly as there is in medical admissions. Be weary of the person that makes it seem as if getting a residency position (or admitted to medical school) seem like an impossible task. Plenty of people do it every year. Situations like that are far from normal.

For USMD students, by far the most common reason for not matching is poor match strategy. There are several forms of this:

1. Not applying to enough programs
2. Not interviewing at enough programs (i.e. turning down too many interviews)
3. Not ranking enough programs (i.e. not ranking several of the programs you did interview at)
4. Not having a backup plan. Applying plastics and a marginal candidate? Also apply to and interview at general surgery programs. Applying derm and a marginal candidate? Also apply to an interview at internal medicine programs

Fortunately most applicants get at least decent advice from their schools and mentors and avoid these really basic mistakes. Unfortunately people do fall through the cracks - there is a poster on allo right now who only ranked 4 programs (out of 10 programs they interviewed at), and was surprised not to match.

I don't like to pile on in those threads, but it is amazing how people get so far through medical school and still don't know these very basic things.

While the SOAP thread horror stories are frightening, it is important to remember the overall numbers. About 95% of US MD students match every year. 50% match to their #1 choice (which would be the premed equivalent of 50% of applicants getting into their top choice medical school), and 80% to one of their top three choices.

And while the SOAP seems like a s**show according to that thread, there is a reason for that. Pretty much all spots in the SOAP are going to good USMD candidates who didn't match; the very worst scraps are all that are left for anyone else.

 

[NickNaylor]

For USMD students, by far the most common reason for not matching is poor match strategy. There are several forms of this:

1. Not applying to enough programs
2. Not interviewing at enough programs (i.e. turning down too many interviews)
3. Not ranking enough programs (i.e. not ranking several of the programs you did interview at)
4. Not having a backup plan. Applying plastics and a marginal candidate? Also apply to and interview at general surgery programs. Applying derm and a marginal candidate? Also apply to an interview at internal medicine programs

Fortunately most applicants get at least decent advice from their schools and mentors and avoid these really basic mistakes. Unfortunately people do fall through the cracks - there is a poster on allo right now who only ranked 4 programs (out of 10 programs they interviewed at), and was surprised not to match.

I don't like to pile on in those threads, but it is amazing how people get so far through medical school and still don't know these very basic things.

While the SOAP thread horror stories are frightening, it is important to remember the overall numbers. About 95% of US MD students match every year. 50% match to their #1 choice (which would be the premed equivalent of 50% of applicants getting into their top choice medical school), and 80% to one of their top three choices.

And while the SOAP seems like a s**show according to that thread, there is a reason for that. Pretty much all spots in the SOAP are going to good USMD candidates who didn't match; the very worst scraps are all that are left for anyone else.

Agreed. Hell, I'm always surprised at how many people don't understand the matching algorithm at all. It's really not that complicated, yet you regularly see people trying to "game" the algorithm for... some reason? 😕

You would think people would spend a little time to do a little research with something that's as important to your career as matching to a residency position. I guess some people are overly confident.

 

[tiedyeddog]

We had one woman in our class rank one program for a ROAD specialty. Unsurprisingly, she had to SOAP.

wtf? I hope she was at least advised by the deans not to do that...

How can someone intelligent/driven enough to get into your medical school do that?

 

[Psai]

There were some people at my school who matched in a different field rather than their relatively noncompetitive first choice and it baffles me as our home program in that field is full of DOs and caribs.

 

[tiedyeddog]

When looking at the SOAP thread you have to take some things into consideration:
1. Many of those people are FMG. It is well known they have far worse odds of scoring any spot.

2. Some of the people in there previously matched and quit/got fired from where they previously matched at. Matching a 2nd time under those conditions isn't going to be easier than the first time.

3. Some of those people are trying to match after being away from clinical medicine for many years (one person was 3 years away from touching a patient). Believe it or not, being a clinician is a use it or lose it type thing. Your skills will atrophy, you are likely going to be out of date with new guidelines and will need to be caught up. Who is a program director of a residency going to take? The person who has atrophied skills or the fresh face who just got done with medical school?

4. Some people are reapplying after a previously failed matched while doing nothing to boost their resumes in the gap. Why would they have any more of a chance to match/SOAP without improving anything in their app?

Most USMD/DO grads do not have to face the 4 things above. You'll be fine, if you follow the advice of NN and SS above. I think when people have any of the things listed above and are then surprised when they don't match it is a lack of knowledge of how medical training in the US works. It's like a one-way train that doesn't make stops. Once you board that train you go until the train comes to the final destination. It's hard to jump back on a moving train once you have jumped off mid-trip. Some people honestly don't know this before going into medicine.

 

[Psai]

I'm reading through that thread now and I'm getting nervous too

 

[IlDestriero]

Don't be delusional about your academic suitability to your desired career.
Apply, interview and rank broadly,
Don't be in the bottom 5% of your class.
Do the above and you should have nothing at all to worry about, assuming your school is in the US.

 

[CaliforniaDreamer]

Can someone give me a breakdown of what all these fricken acronyms mean?

 

[mehc012]

Can someone give me a breakdown of what all these fricken acronyms mean?

http://forums.studentdoctor.net/threads/the-unofficial-official-sdn-pre-med-glossary.523703/
http://www.studentdoctor.net/premedical-student-glossary/?reload=1&r=1427006330813

SOAP itself isn't on there, though, sorry.

It's Supplemental Offer and Assistance Program...aka it's where students who don't match look for positions. Most USMD (US med school) graduates match into a residency program via the NRMP (National resident matching program), all finding out at the same time on match day.

 

[caffeinemia]

Don't be delusional about your academic suitability to your desired career.
Apply, interview and rank broadly,
Don't be in the bottom 5% of your class.
Do the above and you should have nothing at all to worry about, assuming your school is in the US.

Someone's gotta be in the bottom 5%! I guess those people leave medicine, become hospital and insurance administrators and then tell us what to do for the rest of our lives. Nooooooooooooooooooooooooooooo.

 

[NickNaylor]

Can someone give me a breakdown of what all these fricken acronyms mean?

SOAP = Supplementary Offer and Acceptance Program. As mentioned above, this is the pathway used by folks who do not match through the traditional match process. It is not a good thing.

ROAD = radiology, ophthalmology, anesthesiology, and dermatology. It's an acronym that is generally used for competitive lifestyle fields; the ROAD acronym itself is somewhat out of date, but the meaning is the same.

USMD = US MD graduates, i.e., those that graduated from an allopathic school in the US.

FMG = foreign medical graduate, i.e., someone who is not a US citizen and attended a foreign medical school. This is distinguished from IMGs (international medical graduate), which are students that are US citizens but attended a non-US medical school.

I think that was all of them.

 

[TheOcean]

Sometimes it might be back luck. I didn't match into surgery this year. Ranked 10 programs with safeties. Had good interviews, was told I was a strong applicant. Step scores were decent. No red flags. Ranked top 30-40% of my class. Excellent letters of Rec. Many commented on my PS during my interviews. Never once had anyone said "hey you aren't competitive for General surgery".

My friend who also didn't matched ranked 15 programs. Received 25 interviews. Received multiple "we are ranking you high emails". And also didn't match.

There are others like us at our school. Ppl that everyone was shocked didn't match. Sure some ppl no one was shocked...but it doesn't mean that ppl who should of match but didn't don't exist.

 

[NYCdude]

@SouthernSurgeon , do most people who apply to competitive specialties apply to less competitive specialties as a backup?

Seems like a bummer to really want to do for example, ENT, but you put down GS or IM after it and don't really want to do that and then end up being a miserable internist or surgeon.

 

[NYCdude]

It all depends on the individual.

If you are a marginal candidate, then I think it is smart to have some sort of backup plan. The statistics bear that out.

Bottom line is there aren't as many spots in the competitive fields as there are applicants. That may be a bummer but it is what it is.

I also think there are very few people who could truly only be happy in one field. I don't accept that the alternative to not matching ENT is to be miserable. There is too wide a scope in medicine, and too much overlap between different fields.

Thanks! Your posts really help to clear things up, appreciate it man.

 

[chizledfrmstone]

Sometimes it might be back luck. I didn't match into surgery this year. Ranked 10 programs with safeties. Had good interviews, was told I was a strong applicant. Step scores were decent. No red flags. Ranked top 30-40% of my class. Excellent letters of Rec. Many commented on my PS during my interviews. Never once had anyone said "hey you aren't competitive for General surgery".

My friend who also didn't matched ranked 15 programs. Received 25 interviews. Received multiple "we are ranking you high emails". And also didn't match.

There are others like us at our school. Ppl that everyone was shocked didn't match. Sure some ppl no one was shocked...but it doesn't mean that ppl who should of match but didn't don't exist.

If you don't mind me asking, US MD/DO school?

 

[SLC]

Sometimes it might be back luck. I didn't match into surgery this year. Ranked 10 programs with safeties. Had good interviews, was told I was a strong applicant. Step scores were decent. No red flags. Ranked top 30-40% of my class. Excellent letters of Rec. Many commented on my PS during my interviews. Never once had anyone said "hey you aren't competitive for General surgery".

My friend who also didn't matched ranked 15 programs. Received 25 interviews. Received multiple "we are ranking you high emails". And also didn't match.

There are others like us at our school. Ppl that everyone was shocked didn't match. Sure some ppl no one was shocked...but it doesn't mean that ppl who should of match but didn't don't exist.

It happens, it happened to me this year. I had above average scores, grades, etc for the field I applied to (which is a non-competitive field to begin with). I was given excellent feedback "emails about how lucky programs will be if they get me etc". And on interviews had multiple positive comments on my LOR's, one even said that one of my letters was the strongest they'd ever seen.

But I made some mistakes, I limited myself geographically, my top 5 out of 9 were all very very solid upper-tier programs, and I didn't want to play the "send text messages and emails to the residents" game. Looking back, the fact I didn't match doesn't shock me anymore.

My bottom 4 or 5 programs got essentially no follow-up from me, and probably thought I was either not ranking them or not ranking them high enough to waste a high rank on me. My top 3 I have to assume just filled with candidates ranked higher than me on their list. I wouldn't be at all surprised if they filled in their top 10 to 12 as two were very geographically attractive to a good chunk of medical students, and the other might be the single strongest program in the country for procedural training in this field. And I know they all interviewed lots of folks.

To add insult to injury, I cancelled an interview last minute in early January because I was feeling (falsely) confident I'd found my top 3 programs and didn't think this place would change anything about that. Well, they had one spot in the SOAP and if I'd just gone to the interview and ranked the program I almost certainly would have matched, even if I was dead last on their Rank List. Yeah, the SOAP interview with them was awkward.

All that being said, the SOAP was extremely stressful. It took me a full week or so to recover my ability to sleep more than 2-3 hours, I didn't eat much for about 3 days, and I had a nearly constant tension headache. But I had a lot of interest from programs, about 20 different programs interviewed me by Tuesday night. And I got an incredible spot that all told I'm actually extremely happy and excited about. I even had one program that had only one spot to give away, and they called me on Wednesday morning before the first round of offers went out saying they were struggling all night between me and one other candidate. They had decided to send the offer to the other person, but wanted me to wait till the end of the offer acceptance window to accept any offers because if that person declined them they were going to send the offer to me in the second round. They promised to call me the moment they found out so that if they had the offer for me I could consider it against any first round offers I got. I wouldn't have taken it over the offer I accepted in the first round, but they did follow through and notified me when their first round offer was accepted.

So while it was stressful and a bit of a surprise that I didn't match, things worked out really well for me. I couldn't imagine myself being any happier had I matched in my top 3, and I'm certainly relieved that I'm going where im going rather than to one of the places in the bottom half of my ROL. In the end, it worked out kinda nicely. So if you're a good candidate who's from a U.S. school and haven't failed to match or been dropped from a program in years past, it can work out ok, even perhaps better than one hopes!

 

[NYCdude]

It happens, it happened to me this year. I had above average scores, grades, etc for the field I applied to (which is a non-competitive field to begin with). I was given excellent feedback "emails about how lucky programs will be if they get me etc". And on interviews had multiple positive comments on my LOR's, one even said that one of my letters was the strongest they'd ever seen.

But I made some mistakes, I limited myself geographically, my top 5 out of 9 were all very very solid upper-tier programs, and I didn't want to play the "send text messages and emails to the residents" game. Looking back, the fact I didn't match doesn't shock me anymore.

My bottom 4 or 5 programs got essentially no follow-up from me, and probably thought I was either not ranking them or not ranking them high enough to waste a high rank on me. My top 3 I have to assume just filled with candidates ranked higher than me on their list. I wouldn't be at all surprised if they filled in their top 10 to 12 as two were very geographically attractive to a good chunk of medical students, and the other might be the single strongest program in the country for procedural training in this field. And I know they all interviewed lots of folks.

To add insult to injury, I cancelled an interview last minute in early January because I was feeling (falsely) confident I'd found my top 3 programs and didn't think this place would change anything about that. Well, they had one spot in the SOAP and if I'd just gone to the interview and ranked the program I almost certainly would have matched, even if I was dead last on their Rank List. Yeah, the SOAP interview with them was awkward.

All that being said, the SOAP was extremely stressful. It took me a full week or so to recover my ability to sleep more than 2-3 hours, I didn't eat much for about 3 days, and I had a nearly constant tension headache. But I had a lot of interest from programs, about 20 different programs interviewed me by Tuesday night. And I got an incredible spot that all told I'm actually extremely happy and excited about. I even had one program that had only one spot to give away, and they called me on Wednesday morning before the first round of offers went out saying they were struggling all night between me and one other candidate. They had decided to send the offer to the other person, but wanted me to wait till the end of the offer acceptance window to accept any offers because if that person declined them they were going to send the offer to me in the second round. They promised to call me the moment they found out so that if they had the offer for me I could consider it against any first round offers I got. I wouldn't have taken it over the offer I accepted in the first round, but they did follow through and notified me when their first round offer was accepted.

So while it was stressful and a bit of a surprise that I didn't match, things worked out really well for me. I couldn't imagine myself being any happier had I matched in my top 3, and I'm certainly relieved that I'm going where im going rather than to one of the places in the bottom half of my ROL. In the end, it worked out kinda nicely. So if you're a good candidate who's from a U.S. school and haven't failed to match or been dropped from a program in years past, it can work out ok, even perhaps better than one hopes!

Do you mind me asking what field? Also, congrats on matching!

 

[SLC]

Do you mind me asking what field? Also, congrats on matching!

This was Family Med. (Both my initial app, and my SOAP apps). It's not competitive in terms of average scores required, but certain individual programs are highly sought after based on training offered or geographic location (or often even both).

It might be easy to get an interview with a FM program, but matching there is less automatic. Your average chances of being ranked in the top 6-12 applicants, which generally coincides with the number of residents the program hires and therefore will guarantee you a match if you rank the program, are nowhere near as good as people may realize. And if the program is particularly well regarded or sought after like my top 5 were, even a stellar candidate might be ranked far enough down the list that the program is likely to fill without him/her no matter how that candidate ranks the program because there will be 30+ other stellar applicants who could just as easily rank higher.

 

[pharmolu]

So I'm not understanding this not rank enough programs bit. From my understanding, one applies, gets interviews, and ranks everywhere they interview at. Is there any additional benefit from ranking programs one doesn't interview at? Do people actually not rank all the programs they interview at? Or are you saying they don't apply to enough programs, don't get enough interviews and therefore don't rank a lot of places?

 

[NickNaylor]

So I'm not understanding this not rank enough programs bit. From my understanding, one applies, gets interviews, and ranks everywhere they interview at. Is there any additional benefit from ranking programs one doesn't interview at? Do people actually not rank all the programs they interview at? Or are you saying they don't apply to enough programs, don't get enough interviews and therefore don't rank a lot of places?

You can rank whatever programs you want, but you will not be ranked by programs that you didn't interview at.

And yes, there are people that do not rank programs they interview at. This is recommended if you would rather SOAP or risk not being matched for a year rather than end up at one of those programs. Obviously the reasons for not ranking a program should be pretty compelling given the stakes. It also depends on other things, e.g., field you're applying into, overall goals, strength of your application, etc..

 

[DokterMom]

It happens, it happened to me this year. I had above average scores, grades, etc for the field I applied to (which is a non-competitive field to begin with). I was given excellent feedback "emails about how lucky programs will be if they get me etc". And on interviews had multiple positive comments on my LOR's, one even said that one of my letters was the strongest they'd ever seen.

But I made some mistakes, I limited myself geographically, my top 5 out of 9 were all very very solid upper-tier programs, and I didn't want to play the "send text messages and emails to the residents" game. Looking back, the fact I didn't match doesn't shock me anymore.

My bottom 4 or 5 programs got essentially no follow-up from me, and probably thought I was either not ranking them or not ranking them high enough to waste a high rank on me. My top 3 I have to assume just filled with candidates ranked higher than me on their list. I wouldn't be at all surprised if they filled in their top 10 to 12 as two were very geographically attractive to a good chunk of medical students, and the other might be the single strongest program in the country for procedural training in this field. And I know they all interviewed lots of folks.

To add insult to injury, I cancelled an interview last minute in early January because I was feeling (falsely) confident I'd found my top 3 programs and didn't think this place would change anything about that. Well, they had one spot in the SOAP and if I'd just gone to the interview and ranked the program I almost certainly would have matched, even if I was dead last on their Rank List. Yeah, the SOAP interview with them was awkward.

All that being said, the SOAP was extremely stressful. It took me a full week or so to recover my ability to sleep more than 2-3 hours, I didn't eat much for about 3 days, and I had a nearly constant tension headache. But I had a lot of interest from programs, about 20 different programs interviewed me by Tuesday night. And I got an incredible spot that all told I'm actually extremely happy and excited about. I even had one program that had only one spot to give away, and they called me on Wednesday morning before the first round of offers went out saying they were struggling all night between me and one other candidate. They had decided to send the offer to the other person, but wanted me to wait till the end of the offer acceptance window to accept any offers because if that person declined them they were going to send the offer to me in the second round. They promised to call me the moment they found out so that if they had the offer for me I could consider it against any first round offers I got. I wouldn't have taken it over the offer I accepted in the first round, but they did follow through and notified me when their first round offer was accepted.

So while it was stressful and a bit of a surprise that I didn't match, things worked out really well for me. I couldn't imagine myself being any happier had I matched in my top 3, and I'm certainly relieved that I'm going where im going rather than to one of the places in the bottom half of my ROL. In the end, it worked out kinda nicely. So if you're a good candidate who's from a U.S. school and haven't failed to match or been dropped from a program in years past, it can work out ok, even perhaps better than one hopes!

A very insightful post - Thank You. Particularly helpful is the 'hindsight 20/20' of your analysis of where you did go wrong and your positive attitude through the SOAP and aftermath.

Your analysis about how the most desirable programs in even the "least competitive" specialties are also highly sought after is a point too many folks miss. There are many med students who genuinely want to be FPs or OB/Gyns or Psychs, and the very best of those applicants are likely to be as highly qualified as the very best applicants in any of the ROAD specialties. So "above average" applicants in less competitive specialties can expect to match into "above average" programs for those specialties -- probably not the country's best.

Strategy, folks. Know how competitive an applicant you are. Know how competitive your specialty is. Know how popular your preferred locations are, and how popular and highly-ranked the programs in that area are. Apply widely. Interview a lot. And rank every place you could stand to spend a year at, knowing that if you drop to the bottom of your rank order list, it's only because you did not match higher. In other words, if you matched at Yuck U, if you hadn't ranked them, you wouldn't have matched at all.

 

[SLC]

So I'm not understanding this not rank enough programs bit. From my understanding, one applies, gets interviews, and ranks everywhere they interview at. Is there any additional benefit from ranking programs one doesn't interview at? Do people actually not rank all the programs they interview at? Or are you saying they don't apply to enough programs, don't get enough interviews and therefore don't rank a lot of places?

Sometimes people interview somewhere and start to realize they don't want anything to do with that program for one reason or another. They might decide not to rank them as a result.

Other people (like me) get to the point where they think (perhaps erroneously) that some arbitrary number of interviews is enough and stop going on others. There were probably 12-14 interviews I didn't go on because I was feeling good with the ones I had and didn't think I could afford to keep traveling.

You can rank places you don't interview at, but it's pointless as they won't be ranking you!

 

[Zebra Hunter]

It happens, it happened to me this year. I had above average scores, grades, etc for the field I applied to (which is a non-competitive field to begin with). I was given excellent feedback "emails about how lucky programs will be if they get me etc". And on interviews had multiple positive comments on my LOR's, one even said that one of my letters was the strongest they'd ever seen.

But I made some mistakes, I limited myself geographically, my top 5 out of 9 were all very very solid upper-tier programs, and I didn't want to play the "send text messages and emails to the residents" game. Looking back, the fact I didn't match doesn't shock me anymore.

My bottom 4 or 5 programs got essentially no follow-up from me, and probably thought I was either not ranking them or not ranking them high enough to waste a high rank on me. My top 3 I have to assume just filled with candidates ranked higher than me on their list. I wouldn't be at all surprised if they filled in their top 10 to 12 as two were very geographically attractive to a good chunk of medical students, and the other might be the single strongest program in the country for procedural training in this field. And I know they all interviewed lots of folks.

To add insult to injury, I cancelled an interview last minute in early January because I was feeling (falsely) confident I'd found my top 3 programs and didn't think this place would change anything about that. Well, they had one spot in the SOAP and if I'd just gone to the interview and ranked the program I almost certainly would have matched, even if I was dead last on their Rank List. Yeah, the SOAP interview with them was awkward.

All that being said, the SOAP was extremely stressful. It took me a full week or so to recover my ability to sleep more than 2-3 hours, I didn't eat much for about 3 days, and I had a nearly constant tension headache. But I had a lot of interest from programs, about 20 different programs interviewed me by Tuesday night. And I got an incredible spot that all told I'm actually extremely happy and excited about. I even had one program that had only one spot to give away, and they called me on Wednesday morning before the first round of offers went out saying they were struggling all night between me and one other candidate. They had decided to send the offer to the other person, but wanted me to wait till the end of the offer acceptance window to accept any offers because if that person declined them they were going to send the offer to me in the second round. They promised to call me the moment they found out so that if they had the offer for me I could consider it against any first round offers I got. I wouldn't have taken it over the offer I accepted in the first round, but they did follow through and notified me when their first round offer was accepted.

So while it was stressful and a bit of a surprise that I didn't match, things worked out really well for me. I couldn't imagine myself being any happier had I matched in my top 3, and I'm certainly relieved that I'm going where im going rather than to one of the places in the bottom half of my ROL. In the end, it worked out kinda nicely. So if you're a good candidate who's from a U.S. school and haven't failed to match or been dropped from a program in years past, it can work out ok, even perhaps better than one hopes!

You not contacting your bottom 4 or 5 or your perception that they thought you were too good for the program to rank them highly (unless you essentially told them this in the interview) likely had little to do with being ranked by those programs. Programs are in the exact same situation as applicants, they rank based on their preference, not who they think will rank them highly.

 

[SLC]

You not contacting your bottom 4 or 5 or your perception that they thought you were too good for the program to rank them highly (unless you essentially told them this in the interview) likely had little to do with being ranked by those programs. Programs are in the exact same situation as applicants, they rank based on their preference, not who they think will rank them highly.

Well, most of the PD's told me quite differently. They said that if I wanted to go there, I should let them know near the end of the cycle so they could know whether or not they "had a chance" with me. I very much got the impression that they ranked to fill first and foremost, not necessarily 100% by preference.

And I definitely know that other programs I interviewed have the residents meeting to make the rank list. They rank the people they know and like, based either on getting to know the applicants through post-interview communication or through away-rotations. One of those programs was my #3, and in a high-desirability location where I'm sure the program doesn't dig deep into the rank list in any given year.

 

[NickNaylor]

Well, most of the PD's told me quite differently. They said that if I wanted to go there, I should let them know near the end of the cycle so they could know whether or not they "had a chance" with me. I very much got the impression that they ranked to fill first and foremost, not necessarily 100% by preference.

And I definitely know that other programs I interviewed have the residents meeting to make the rank list. They rank the people they know and like, based either on getting to know the applicants through post-interview communication or through away-rotations. One of those programs was my #3, and in a high-desirability location where I'm sure the program doesn't dig deep into the rank list in any given year.

It sounds like you interviewed at a bunch of places whose PDs don't understand the match algorithm or who are delusional with respect to the importance of matching as high up the rank list as possible (as if anyone knows or cares).

 

[Zebra Hunter]

Well, most of the PD's told me quite differently. They said that if I wanted to go there, I should let them know near the end of the cycle so they could know whether or not they "had a chance" with me. I very much got the impression that they ranked to fill first and foremost, not necessarily 100% by preference.

And I definitely know that other programs I interviewed have the residents meeting to make the rank list. They rank the people they know and like, based either on getting to know the applicants through post-interview communication or through away-rotations. One of those programs was my #3, and in a high-desirability location where I'm sure the program doesn't dig deep into the rank list in any given year.

I am going to doubt that 5+ programs told you that they don't rank by preference because that would mean that more than half of the PDs you interviewed with don't know how the match algorithm works. I have never heard of a program "ranking to fill" because it makes no sense. As long as the applicant is somewhere on their rank list, they don't have to worry about going unfilled.

 

[WingedOx]

I am going to doubt that 5+ programs told you that they don't rank by preference because that would mean that more than half of the PDs you interviewed with don't know how the match algorithm works. I have never heard of a program "ranking to fill" because it makes no sense. As long as the applicant is somewhere on their rank list, they don't have to worry about going unfilled.

You'd be surprised at peoples' cluelessness. I'm good friends with scramblers partially because the chair of one of the best programs in the region though only ranking a 4/1 ratio of ranked candidates to spots would be a good idea. needless to say he didn't do that again.

 

[SLC]

I am going to doubt that 5+ programs told you that they don't rank by preference because that would mean that more than half of the PDs you interviewed with don't know how the match algorithm works. I have never heard of a program "ranking to fill" because it makes no sense. As long as the applicant is somewhere on their rank list, they don't have to worry about going unfilled.

They didn't explicitly tell me they "rank to fill". They told me that if I wanted to be there, I needed to let them know in time for rank list submission. They said they only interview people they would rank highly and that the way to get to the top of their list is to let them know you wanted to be there.

I take this to mean that they plan to rank the people who specifically express their desire to match with those programs higher than the ones who don't express such a desire.

Programs that don't fill, often do so because the people they want, didn't want them. Some programs seek to prevent this by preferentially ranking people that express a desire to be there in post interview communication. They want to put people high on their list who they feel have a higher chance of doing the same in return. A mutual expression of interest if you will.

It's as close to "I'll rank you #1 if you rank me #1 as you can get without violating the NRMP rules"

 

[WingedOx]

They didn't explicitly tell me they "rank to fill". They told me that if I wanted to be there, I needed to let them know in time for rank list submission. They said they only interview people they would rank highly and that the way to get to the top of their list is to let them know you wanted to be there.

I take this to mean that they plan to rank the people who specifically express their desire to match with those programs higher than the ones who don't express such a desire.

Programs that don't fill, often do so because the people they want, didn't want them. Some programs seek to prevent this by preferentially ranking people that express a desire to be there in post interview communication. They want to put people high on their list who they feel have a higher chance of doing the same in return. A mutual expression of interest if you will.

It's as close to "I'll rank you #1 if you rank me #1 as you can get without violating the NRMP rules"

yeah, again, that's not understanding how the program works.

 

[SLC]

yeah, again, that's not understanding how the program works.

It is, it's called "hedging your bets". They know that if they have applicants telling them they're ranking them highly, they have a high chance of getting those same applicants if they reciprocate. It's a desire to fill with people who are actually excited to be there.

If your strategy was to only interview folks who you were already very excited about on paper; then ideally fill with the ones who were most excited to join your team, this strategy makes perfect sense. As long as the applicants are honest with you, you can basically all but guarantee yourself a good outcome.

 

[WingedOx]

It is, it's called "hedging your bets". They know that if they have applicants telling them they're ranking them highly, they have a high chance of getting those same applicants if they reciprocate. It's a desire to fill with people who are actually excited to be there.

If your strategy was to only interview folks who you were already very excited about on paper; then ideally fill with the ones who were most excited to join your team, this strategy makes perfect sense. As long as the applicants are honest with you, you can basically all but guarantee yourself a good outcome.

From a program's end, ranking a candidate higher doesn't directly increase the odds of matching that candidate unless said candidate fails to land at choices higher than you. There is absolutely no detriment to the program for ranking the kids with 270s from Harvard who are fluent in 10 languages and have LORs from Nobel laureates over the people they think are more likely to come.

The list-maker's job is to try to get the best candidates possible, and make the list as such, even if they don't think they have a shot at some of them.

 

[SLC]

It is my understanding that ranking the people/programs you want is the only strategy. And what I am saying is that I left with the impression that the PD's "want" the candidates that express their love for the program.

I didn't do that, and I expect that this resulted in my falling below those who did on the ROL.

I can only relate what I was told during the interviews.

 

[NickNaylor]

It is my understanding that ranking the people/programs you want is the only strategy. And what I am saying is that I left with the impression that the PD's "want" the candidates that express their love for the program.

I didn't do that, and I expect that this resulted in my falling below those who did on the ROL.

I can only relate what I was told during the interviews.

FWIW, we had a panel of PDs that came and spoke to the M4s back in the fall when we were preparing to apply. Our of the 5-6 PDs there, it was universal that e-mails along the lines of "I'm ranking you [something high]" had an inconsequential to zero impact on their ranking of you. It just doesn't make sense that it would. There is no reason that a PD would change their rank list based on what an applicant tells them. If the applicant is, in fact, ranking them highly, then the applicant will likely match there if the program ranks them high enough. If the applicant doesn't want to be there, then they will likely match somewhere higher up on their own list. A PD ranking someone higher strictly by virtue of whether or not they express interest in the program is ludicrous.

All that being said, it also wouldn't surprise me to hear that some PDs do, in fact, do things like this. Misunderstanding what the match algorithm does and does not do is not uncommon, and I was told by my own adviser that there are in fact some PDs who take pride in not going far down their ROL - even though, again, no one would ever know how far the program went down the list save for the people in the program themselves.

 

[gostudy]

Every program is different. Some rank you right on interview day and the list is frozen in stone no matter what post-interview love note, call, or text comes their way. Some programs manipulate and change their lists to the bitter end based on feedback from applicants. Although, I would say that as a PD I would want candidates (as long as they passed some predetermined competency threshold) that had me high on their rank lists more than candidates for whom I was far down their list...but I'm not a PD. Either way, mind your manners and send thank you notes/cards. It won't hurt you to write and it may hurt you not to write. A handwritten note is a nice touch, but won't earn you extra points. In terms of getting ahead in the match process e-mails or cards go to the same place: your applicant file and are marked as a post-interview contact with the program.

 

[DokterMom]

It is my understanding that ranking the people/programs you want is the only strategy. And what I am saying is that I left with the impression that the PD's "want" the candidates that express their love for the program.

I didn't do that, and I expect that this resulted in my falling below those who did on the ROL.

I can only relate what I was told during the interviews.

Seems to me that a bunch of applicants would be about equal from a program's perspective -- say 7/10 -- and that a PD would prefer to have, from those about equal candidates, the ones that were most happy to be going there. So love notes could matter within that 'about equal' range. (No one wants a disgruntled intern.) But I doubt even the most ardent love notes could move you from the top of the 7/10 pack into the 8/10 pack.

 

[SLC]

Seems to me that a bunch of applicants would be about equal from a program's perspective -- say 7/10 -- and that a PD would prefer to have, from those about equal candidates, the ones that were most happy to be going there. So love notes could matter within that 'about equal' range. (No one wants a disgruntled intern.) But I doubt even the most ardent love notes could move you from the top of the 7/10 pack into the 8/10 pack.

No idea really. All I know is that this was a common theme from PD's...that if I really wanted to be there I should make sure to let them know.

 

[NickNaylor]

Seems to me that a bunch of applicants would be about equal from a program's perspective -- say 7/10 -- and that a PD would prefer to have, from those about equal candidates, the ones that were most happy to be going there. So love notes could matter within that 'about equal' range. (No one wants a disgruntled intern.) But I doubt even the most ardent love notes could move you from the top of the 7/10 pack into the 8/10 pack.

But if you understand the algorithm it doesn't make any difference at all...

 

[PL198]

No idea really. All I know is that this was a common theme from PD's...that if I really wanted to be there I should make sure to let them know.

yeah I don't really think it's ever going to hurt you. worst case scenario you give the PD a little validation boost

 

[PL198]

But if you understand the algorithm it doesn't make any difference at all...

how so? you don't think hearing that someone loves a program might make a program move a candidate up even one spot possibly?