Why do applicants not rank programs?

[cookymonster]

The only reason I can think of is if you had such a horrible interview day that you decided that you'd rather try your chances at the scramble.

Still, the scramble sounds miserable, and from the tone of some posts I read last year, some people declined to rank certain programs without a particularly glaring reason - they just felt like they had ranked enough already. While that's usually true, where's the harm in ranking your last choices anyway? Does the NRMP charge some exorbitant fee after you rank a certain # of programs?

I feel like I'm missing something. Anyone?

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[AttyHubby]

The only reason I can think of is if you had such a horrible interview day that you decided that you'd rather try your chances at the scramble.

Still, the scramble sounds miserable, and from the tone of some posts I read last year, some people declined to rank certain programs without a particularly glaring reason - they just felt like they had ranked enough already. While that's usually true, where's the harm in ranking your last choices anyway? Does the NRMP charge some exorbitant fee after you rank a certain # of programs?

I feel like I'm missing something. Anyone?

Because they're stupid?

I'm with you, I can't think of a single good reason to not rank a program you interviewed with. Not one. No sane person would rather go through the scramble.

 

[cookymonster]

Makes perfect sense to me. What makes it even more stupid is that should you omit certain programs and somehow not match, you can't even really scramble for open spots at the schools you rejected.

That would be the mother of all karmic catastrophes. Glad to hear that someone is on the same page.

 

[WhoisJohnGalt]

The only reason I can think of is if you had such a horrible interview day that you decided that you'd rather try your chances at the scramble.

This is the only valid reason, and from what I hear it's more common than you make it sound. If you KNOW that Program A is horrible, wouldn't you rather take your chances on Program B (that you find in the scramble) that might be less horrible than sign up for 3+ years of <definitely horrible> Program A? Clearly, that kind of arithmetic only works if you really hated Program A, but that seems to happen often enough.

 

[AttyHubby]

This is the only valid reason, and from what I hear it's more common than you make it sound. If you KNOW that Program A is horrible, wouldn't you rather take your chances on Program B (that you find in the scramble) that might be less horrible than sign up for 3+ years of <definitely horrible> Program A? Clearly, that kind of arithmetic only works if you really hated Program A, but that seems to happen often enough.

That's a pretty huge gamble. Losing out on a spot in a program for the chance to go through the most miserable process of your life (seriously, read the threads on here about scrambling. 3 phones, a fax, multiple computers, multiple assistants? holy crap)? Honestly, it's not like the programs that end up with spots in the scramble are going to be super duper, they didn't fill for a reason.

The only way I can see it being reasonable is if you would honestly rather SIT OUT a year than go there for residency. The scramble is too much of a gamble since you may end up somewhere just as bad or worse (or nowhere at all, plenty of people find nothing in the scramble).

 

[cookymonster]

This is the only valid reason, and from what I hear it's more common than you make it sound. If you KNOW that Program A is horrible, wouldn't you rather take your chances on Program B (that you find in the scramble) that might be less horrible than sign up for 3+ years of <definitely horrible> Program A? Clearly, that kind of arithmetic only works if you really hated Program A, but that seems to happen often enough.

I agree that some programs may be perceived to be horrible, but what seems strange to me is that people only realize this after an interview day without realizing it when they applied. I dunno, I guess it's hard for me to imagine how an interview day could be THAT bad. Maybe if a patient called me a racial slur or if the residents thought amiodarone and amlodipine were the same thing, I'd drop it from consideration. Otherwise, it's at least a place I can get paid to be a doctor. One can usually switch into another program after a year if it's really that bad.

The big problem with the scramble is that while you MIGHT scramble into a better program than a bad one at which you interviewed, you might also come away empty-handed (the # of spots in the scramble is unpredictable and it can be extremely low). The prospect of not matching, at least to me, is several orders of magnitude more horrible than matching at a horrible program, so I'd rather minimize that risk as much as possible.

 

[smq123]

Because they're stupid?

I'm with you, I can't think of a single good reason to not rank a program you interviewed with. Not one. No sane person would rather go through the scramble.

You clearly have not been out on the interview trail.

I agree that some programs may be perceived to be horrible, but what seems strange to me is that people only realize this after an interview day without realizing it when they applied. I dunno, I guess it's hard for me to imagine how an interview day could be THAT bad.

Again, wait until you hit the interview trail.

ALL programs look fantastic on paper. It's very much like internet dating. Some guys look great on their profile....and then you meet them in person, and they're feeling up waitresses, being rude to bartenders, and smashing their fists into walls if someone cuts into line in front of them. Not good.

There are some genuinely awful programs out there that, by normal standards, look fine. I remember interviewing at one program like that last year. On paper, it's a great program. They train their residents well, their grads get into fantastic fellowships, etc.

During the interview day, though, 3 of the interns looked exhausted, beat down, and on the verge of tears. The faculty had their faces twisted into a rictus of fake good cheer, and left as soon as they could. I overheard 3 senior residents talking about how much they hated the junior residents. One junior resident said, "This program...isn't....THAT...malignant." Etc.

I had classmates who went to interviews where the program director would say "We're in compliance with the 80 hour work week," and the residents in the back would snicker derisively. Others went to interviews where interns would pull them aside and say, "If I had to do it again, I would NEVER come here. EVER."

Yeah, some places really are THAT bad.

Makes perfect sense to me. What makes it even more stupid is that should you omit certain programs and somehow not match, you can't even really scramble for open spots at the schools you rejected.

Of course you can scramble for those open spots. If you're in the scramble, all open spots are fair game for you. Why can't you?

 

[cookymonster]

Of course you can scramble for those open spots. If you're in the scramble, all open spots are fair game for you. Why can't you?

Because there are presumably others in the scramble that can scramble into those spots who haven't rejected that program already. I mean, if you essentially tell the program that your opinion of them is so low that you'd rather scramble than match into it, why would they take someone who clearly has no desire to be there?

This is under the assumption that programs have some selectivity during the scramble. That may depend on the specialty; I honestly don't know.

 

[Doctor Bagel]

I think some programs are bad enough that I'd rather wait out a year or do a prelim year than go there. I rotated at one -- they exist. In fact, the program was so miserable that all the interns left at the end of the year, and one of the senior residents went on vacation and didn't come back. I don't know how many programs are out there that are like this, but there are at least some.

 

[tfom08]

What about weather? Someone might interview in Chicago or Minnesota during the winter and decide that, although they love the programs, they really would not be happy at all living in weather that cold for a few months each year. I've heard people say this has happened to them. You would think they would know before they apply, but when the winter wind in Chicago hits you, it can be a shock for someone not used to that kind of weather.

If you decide you would rather scramble anywhere warm than deal with the weather for 3-5 years, then more power to you.

 

[SocialistMD]

Because there are presumably others in the scramble that can scramble into those spots who haven't rejected that program already. I mean, if you essentially tell the program that your opinion of them is so low that you'd rather scramble than match into it, why would they take someone who clearly has no desire to be there?

There's also the chance that they didn't rank you, either.

 

[smq123]

Because there are presumably others in the scramble that can scramble into those spots who haven't rejected that program already. I mean, if you essentially tell the program that your opinion of them is so low that you'd rather scramble than match into it, why would they take someone who clearly has no desire to be there?

This is under the assumption that programs have some selectivity during the scramble. That may depend on the specialty; I honestly don't know.

Eh. You may, on second thought, try and scramble into that program. Or, if your opinion of that program was really that low, you might not even try scrambling into that program.

Either way, there's nothing stopping you from eventually scrambling into that program, even if you didn't rank it the first time around.

 

[NotAProgDirector]

The scramble can be 24-72 hours of hell.

Matching into a program that is not a good fit for you can be a year of hell. Although this could be because the program completely sucks (as mentioned above), it could also be a good program that just doesn't meet your needs. Residency is very busy, and if you don't like it your performance can suffer.

Note: the scramble for the 2011 match (NOT THIS MATCH, DO NOT PANIC NOW) is going to be a whole new animal, managed by the NRMP. Details are on their website. Interestingly, one of the issues / concerns raised was that if they make the scramble more humane, students might shorten their rank lists, as the risks involved in not matching would be lower. I think this is crazy, as med students are one of the most OCD group of people I know.

 

[Law2Doc]

What about weather? Someone might interview in Chicago or Minnesota during the winter and decide that, although they love the programs, they really would not be happy at all living in weather that cold for a few months each year. I've heard people say this has happened to them. You would think they would know before they apply, but when the winter wind in Chicago hits you, it can be a shock for someone not used to that kind of weather.

If you decide you would rather scramble anywhere warm than deal with the weather for 3-5 years, then more power to you.

Bad logic. You have a lot less control in the scramble. You are competing for leftovers, and the more desirable specialties and locations might be gone before you ever get through to a program director. So you may end up losing a shot at Chicago only to end up scrambling into a less benign program in a colder, windier city. The match is your best shot at having some control. The scramble is about grabbing up something-- anything-- that will continue your career progression, even if it means suffering it out a few years. Never get into the mindset that you are going to find something better in the scramble. That's like skipping the meal on the table and trying to find something tastier in the trash can. Sometimes you luck out and something good has been discarded, but no one smart would bypass the table unless what was being served was truly unpalatable.

 

[ShyRem]

Think about giving up Chicago to scramble into Kingman AZ. I'd take Chicago any day -- even if I hated winter.

 

[NotAProgDirector]

Basic match rule of thumb #1:

Scramble = bad idea, avoid at all costs. Plenty of tales of scramble woe on SDN.

Basic match rule of thumb #2:

Matching into a program you didn't like / had reservations about = usually worse than scramble. Programs are at their best on interview days.

 

[Law2Doc]

Basic match rule of thumb #1:

Scramble = bad idea, avoid at all costs. Plenty of tales of scramble woe on SDN.

Basic match rule of thumb #2:

Matching into a program you didn't like / had reservations about = usually worse than scramble. Programs are at their best on interview days.

I kind of disagree with your second rule. You can very easilly trade down from bad to worse, or often nothing at all. A malignant place that let's you keep your career on track is still going to be preferable to the scramble, which doesn't even provide that guarantee. Plenty of people still end up with nothing after the scramble ends. So anything you don't rank had better be worse than nothing.

 

[smq123]

A malignant place that let's you keep your career on track is still going to be preferable to the scramble, which doesn't even provide that guarantee.

True....but a malignant place that makes you so miserable that -

* you don't want to study and fail your boards,
* you start abusing drugs and alcohol,

or

* you wind up quitting

is going to be worse than the scramble. So I kind of agree with his rule.

 

[Law2Doc]

True....but a malignant place that makes you so miserable that -

* you don't want to study and fail your boards,
* you start abusing drugs and alcohol,

or

* you wind up quitting

is going to be worse than the scramble. So I kind of agree with his rule.

Nah-- I know many more people toughing it out in bad situations than turning to a life of drugs and failing out. More people manage than not in such situations. So it's still usually better than chancing it and getting nothing in the scramble.

 

[smq123]

Maybe....

I agree, no matter how you look at it, the scramble is a gamble. But I firmly believe that there are programs that are so bad that you would be better sitting out a year than risk 3-6 years of misery. In that case, it might be better to sit out and try to match again the next year, than be miserable for so long. It's up to the individual applicant, obviously.

 

[Apollyon]

The NRMP says "only rank places you are willing to go".

That's about as crystal clear as it can get - you go on 12, don't like one at all, and tell yourself you would NEVER go there, so you rank 11.

It is a bit spazzy to think "Rank N, match, Rank N-1 --> scramble!" Only VERY marginal candidates (like I was) had to rank every place at which they interviewed (because I didn't get many interviews). Alternately, if you are applying for a VERY competitive specialty, where you would go ANYWHERE to get training in that field, then you would rank all places - because you would be willing to go there. When I was a med student all those years ago, there was an ortho resident at the program where I was doing my surgery core. He had interviewed at 16 places - and matched at #16. He wanted to be (and now is) an orthopod, so he took it.

The only thing worse than scrambling is scrambling twice. Believe me, I know. Still, I ended up with a Duke residency certificate, so I'll take it.

 

[EM2BE]

Scrambling is a horror. (I helped someone scramble last year.) Yet, I have found one place I am still deciding if I would rather scramble than go there. Some places can be that bad of a fit. I don't think I could deal with the place for 4 years when I was miserable for the 9-10 months I was there. I am one of those that doesn't learn as much when I am unhappy with where I am. I know that and accept it and take it into consideration when making these decisions.

 

[Law2Doc]

...
It is a bit spazzy to think "Rank N, match, Rank N-1 --> scramble!" Only VERY marginal candidates (like I was) had to rank every place at which they interviewed (because I didn't get many interviews). Alternately, if you are applying for a VERY competitive specialty, where you would go ANYWHERE to get training in that field, then you would rank all places - because you would be willing to go there. ...

About 80% of US applicants get one of their top three ranked choices. But of that remaining 20%, a pretty substantial portion end up having to rank every interview or risk scrambling. We all probably know many people who were happy to have ranked places lower on their list because those were the ones that actually panned out.

And I agree with the highly competitive fields -- you take what you can get, because not everybody is going to get into that field at all, and it's the difference between a potentially malignant couple of years to keep you on track for the career you want, or a less malignant residency but perhaps a lifetime of being bummed out that you aren't doing what you wanted.

Bottom line is that the scramble is a gamble, and not a smart gamble. A lot of the places that fall into the scramble end up there because people have good reasons not to rank them. So while you may think a place you interviewed at is too malignant to rank, you may end up having to scramble into a program that several other people didn't rank for the same reason. Sometimes a good place falls through the cracks, but the odds of that are never worth banking on. The devil you know/choose is usually better than the one forced upon you. As for sitting out a year to avoid a malignant path, while that is an option, most people with mountains of debt and anxious to start in on their career would probably rather suffer through some malignancy and keep their career moving rather than try again in a year, without much promise for things being better next time around.

 

[kralwok]

i didn't rank a program, because i was couples matching and my spouse's corresponding program was not acceptable to him.

 

[Ashers]

I scrambled, and I ranked every interview I attended. There were 2 places that I thought about leaving off because I really didn't like the program, but I didn't want to risk not matching. In the end I ranked 14, and I was praying I wouldn't match into the last 2. I thought I had an awesome chance at the first 5.

Anyway, I was super-lucky in the scramble that I got to go into departments at my own school who knew me, and the end specialty is one that I had considered switching into.