What makes you not rank a program?

[wannabeOBGYN]

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Does anybody have any "deal-breakers" that force a program off their rank list? What are those deal-breakers? Has anybody had an experience or interaction at an interview that caused them to reconsider to the point of not ranking a program?

So far the only thing I've come across as a deal-breaker is currently being on probation. However, there is one program I interviewed with that is at the bottom of my list and I'm trying to figure out how much I have to dislike a program to be willing to scramble instead of being there. It's a scary thought, so I figured it'd be helpful to see what sort of parameters other people have set in deciding not to rank a program. Thanks.

 

[Law2Doc]

Does anybody have any "deal-breakers" that force a program off their rank list? What are those deal-breakers? Has anybody had an experience or interaction at an interview that caused them to reconsider to the point of not ranking a program?

So far the only thing I've come across as a deal-breaker is currently being on probation. However, there is one program I interviewed with that is at the bottom of my list and I'm trying to figure out how much I have to dislike a program to be willing to scramble instead of being there. It's a scary thought, so I figured it'd be helpful to see what sort of parameters other people have set in deciding not to rank a program. Thanks.

There are definitely programs out there where they work you harder than normal for the specialty, where the residents aren't all that well regarded by the attendings, and where the level of collegiality isn't where it ought to be for a teamwork focused profession. If you come across a place like this, you might reasonably decide you'd be better off leaving it off your rank list. Makes more sense for noncompetitive things (especially prelim years) where your odds of replacing it in the scramble aren't absurd. But the key is to ferret out such places, since most can hide it well during interviews. Your best bet is to talk to alumni from your school at such a program and get the real skinny.

I personally didn't leave any places I interviewed off my list, but have subsequently learned things about certain programs that make me realize I dodged a bullet.

 

[splik]

1. You really could not live in the location (or you would be miserable)
2. They don't provide you with enough vacation (2 weeks/year is a dealbreaker)
3. The residents didn't know wtf they were doing/talking about
4. The resident were overworked
5. Something was just very wrong on the day
6. Interviewers were openly hostile, antagonistic, racist, sexist, xenophobic, homophobic etc.

 

[Cathyran]

1. You really could not live in the location (or you would be miserable)
2. They don't provide you with enough vacation (2 weeks/year is a dealbreaker)
3. The residents didn't know wtf they were doing/talking about
4. The resident were overworked
5. Something was just very wrong on the day
6. Interviewers were openly hostile, antagonistic, racist, sexist, xenophobic, homophobic etc.

This, and I'll add, if the residents openly state "Seriously, don't come here, it sucks." This actually happened to me at a prelim interview. Needless to say, I'm not ranking this program.

 

[Law2Doc]

This, and I'll add, if the residents openly state "Seriously, don't come here, it sucks." This actually happened to me at a prelim interview. Needless to say, I'm not ranking this program.

This should definitely be the number one reason not to rank a place. If it's so bad they cant even hide the discontent on interview day, it's not going to be better on the days where there's no free food.

 

[Law2Doc]

1. You really could not live in the location (or you would be miserable)
2. They don't provide you with enough vacation (2 weeks/year is a dealbreaker)
3. The residents didn't know wtf they were doing/talking about
4. The resident were overworked
5. Something was just very wrong on the day
6. Interviewers were openly hostile, antagonistic, racist, sexist, xenophobic, homophobic etc.

Bear in mind that "overworked" is relative. All residents in certain fields will be overworked by med student standards, but perhaps not for the specialty. And if you interview early in the interview season, finding interns that "don't know wtf they are doing/talking about" is not so big a deal. If you interview in January and they still don't know, that's a different story.

 

[kentuckyguy84]

1. You really could not live in the location (or you would be miserable)
2. They don't provide you with enough vacation (2 weeks/year is a dealbreaker)
3. The residents didn't know wtf they were doing/talking about
4. The resident were overworked
5. Something was just very wrong on the day
6. Interviewers were openly hostile, antagonistic, racist, sexist, xenophobic, homophobic etc.

I'd highlight 1, 5, and 6. I experienced each one of these at separate places and have considered not ranking them. Most likely will rank anyway for fear of having to scramble if I don't, but they're gonna be dead last.

 

[FutureDoc734]

1. You really could not live in the location (or you would be miserable)
2. They don't provide you with enough vacation (2 weeks/year is a dealbreaker)
3. The residents didn't know wtf they were doing/talking about
4. The resident were overworked
5. Something was just very wrong on the day
6. Interviewers were openly hostile, antagonistic, racist, sexist, xenophobic, homophobic etc.

#1 and #5 would be top on my list. Although, even with that, I'll rank them last instead of take them off my list - our school is strongly suggesting that we rank all programs we interviewed at, just because of the competitiveness of the current matching process.

 

[mcl]

Would anyone care to be more specific about #5 ("something was just very wrong on the day"). Was it that the day didn't seem well planned, or that an interviewer cancelled, or something worse? Seriously--things go wrong (I used to have a list of seven things that could go wrong by 7 a.m.) and it would help to know the kinds of scenarios that would make an applicant DNR a program.

 

[FutureDoc734]

Would anyone care to be more specific about #5 ("something was just very wrong on the day"). Was it that the day didn't seem well planned, or that an interviewer cancelled, or something worse? Seriously--things go wrong (I used to have a list of seven things that could go wrong by 7 a.m.) and it would help to know the kinds of scenarios that would make an applicant DNR a program.

One example that I can give: at the night-before social, only two (out of 30+ residents) showed up. Furthermore, on interview day, there were very few residents around, and the ones that were available didn't seem very interested in talking to us or getting to know us. That's a big red flag for me.

Hope this helps.

 

[2012mdc]

Would anyone care to be more specific about #5 ("something was just very wrong on the day"). Was it that the day didn't seem well planned, or that an interviewer cancelled, or something worse? Seriously--things go wrong (I used to have a list of seven things that could go wrong by 7 a.m.) and it would help to know the kinds of scenarios that would make an applicant DNR a program.

I've had a couple instances where an interviewer cancelled and it was not a big deal at all. At one program we had 6 interviews instead of 7 which was fine by me and at another they got a last minute replacement (who still made the effort to glance at my app)

I feel like #5 can also be related to a gut feel/overall vibe which is connected to the program at large and out of the PC's control. Things like cancellations are part of life. Some days could be organized better but you never know the reasoning behind the schedule and it's definitely not a big enough to deal to cause a DNR

 

[mave]

My "something wrong with the interview day" was that it was hard to get the residents to talk about the program itself. They were psyched to talk about how great their fellowship match was, and that their in-house fellowships took a lot of people from within the residency. They were thrilled to talk about the city that the program was in. But they wouldn't answer questions about the program. And I had several residents tell me that the program wouldn't be a good fit for me because they didn't have the fellowship I'm interested in. The last point in particular smelled funny to me, because it felt a little like they don't have confidence that their residents can get fellowships at other institutions.

 

[pingouin]

One example that I can give: at the night-before social, only two (out of 30+ residents) showed up. Furthermore, on interview day, there were very few residents around, and the ones that were available didn't seem very interested in talking to us or getting to know us. That's a big red flag for me.

Hope this helps.

I had a similar experience at one of my interviews.

Also, another program flat-out told us that they do not have a pre-interview social with the residents and could not validate our parking in the university hospital's garage because "our department doesn't have the money for that". That told me a lot about what kind of resources/support may (not) be available to the residents.

 

[mcl]

Thanks for the thoughtful responses. I have a lot of respect for the "gut feeling" about programs and counsel our students to pay attention to that feeling. I'm relieved to hear that the decision to not rank a program typically doesn't involve the unanticipated logistical problems that can occur on any given day.

 

[gutonc]

I'm relieved to hear that the decision to not rank a program typically doesn't involve the unanticipated logistical problems that can occur on any given day.

Sometimes it does, but you don't want to match those people to your program anyway.

 

[HappyG0Lucky]

I asked an intern at one program what she liked about the place. She thought for a moment and said, 'honestly i can't think of anything good right now" Probably not going to rank that one...

 

[gutonc]

I asked an intern at one program what she liked about the place. She thought for a moment and said, 'honestly i can't think of anything good right now" Probably not going to rank that one...

This is the problem with having interview season at the nadir of intern year. Trust me, no matter how awesome your program, you will never be closer to killing yourself than you will be in the November - February period of intern year. Trying to make people like that put on a happy face and recruit the next batch of suckers/interns is a recipe for disaster.

 

[Law2Doc]

I asked an intern at one program what she liked about the place. She thought for a moment and said, 'honestly i can't think of anything good right now" Probably not going to rank that one...

In addition to what gutonc said, make sure that person wasn't a prelim. They are sometimes just biding their time until they can start in the specialty they actually care about, and so no matter how great the program they probably will be regarding it as doing their time.

 

[Dr. USMLE]

Thanks for the thoughtful responses. I have a lot of respect for the "gut feeling" about programs and counsel our students to pay attention to that feeling. I'm relieved to hear that the decision to not rank a program typically doesn't involve the unanticipated logistical problems that can occur on any given day.

I would add that it may be more useful to ask what would persuade applicants to rank a program in the bottom third, as few applicants have the luxury of DNRing even what seems like a malignant or otherwise non-reputable program.

Although there is only one program I may DNR this match, I will say that my pre-interview ROL differs markedly in the middle and bottom of the list compared to my post-interview ROL.

As far as "gut feel," for me this was largely determined by the PD's personality. IMO, recruiting the highest calibre of applicants requires a charismatic leader.

 

[HappyG0Lucky]

In addition to what gutonc said, make sure that person wasn't a prelim. They are sometimes just biding their time until they can start in the specialty they actually care about, and so no matter how great the program they probably will be regarding it as doing their time.

In this case, she was not a prelim (there are none in the specialty I'm applying for) and to make matters worse, at the applicant dinner no residents even showed up at all. However, my particular experience aside, i think your point is well taken!

 

[wannabeOBGYN]

Am I wrong to not rank a program on probation? I haven't seen anybody else mention this and now I'm wondering if I'm being too harsh. I just don't want to get a year or two into a program (or worse, just match there, since the program in question finds out their results this spring) and then have to find somewhere else to go, especially when there's 10 people per year that would be looking for those few open spots to switch to.

 

[splik]

No it isn't wrong. But things to consider - do you have enough other places to rank? (10 is about 95% chance of matching for OB/GYN) Did they appear to making the required changes for their next review? How did the residents feel about it - were they worried? The risk of going into a program like that is not just that it will have its accreditation revoked (which doesn't happen all that often) but that it really could have an adverse effect on the atmosphere of the place and ultimately impact on what you get out of your training. The majority of programs are not on probation so they are clearly doing something wrong even if it is just working the residents to the bone!

 

[mcl]

Am I wrong to not rank a program on probation? I haven't seen anybody else mention this and now I'm wondering if I'm being too harsh. I just don't want to get a year or two into a program (or worse, just match there, since the program in question finds out their results this spring) and then have to find somewhere else to go, especially when there's 10 people per year that would be looking for those few open spots to switch to.

I think the answer is going to depend on how many places you visited, how competitive you think you are at those places, and whether the program in question did anything during your visit to let you know that the problems causing the probation had been addressed and fixed. If they have gone through their site visit and are awaiting results they probably have a feel for what the site visitor planned to put in his/her report. At least my program's site visitor did that at the end of day when we were reviewed in October.

It's definitely a risk, so I couldn't recommend ranking the program highly. But if you didn't hate it and the residents seemed optimistic about post-probation changes making the program stronger, you'd probably be OK if you ended up there.