Creating Your Rank List

This post is for all the current and future fourth years out there who are making a rank list – it’s an overwhelmingly important decision and you’re almost certainly going to second guess yourself at least a little. Although I definitely had more flexibility in my free time and really enjoyed the absence of regular testing in MS4, I think I was just about as anxious as I had been throughout medical school just because so much feels like it’s being left up to fate, and that was kind of tough to deal with! There’s nothing left to do but decide where you’d like to spend the next 3-7 years of your life and then to wait and hope that it works out the way you want it to. The good news is that it ends pretty well for most everyone I know!

The biggest piece of advice I got and will give is that you need to trust your gut. I was actually interviewing at U Chicago when my now-program director was chatting with us and told us about how she’d created spreadsheets on spreadsheets of things that she like and didn’t like about the various programs she’d visited, but in the end decided to trust herself about what she wanted and picked what felt right. At the time of that conversation, I was about halfway through interviews and had definitely been making some spreadsheets of my own. What I realized was that I was tweaking some of the things I was putting into each column to make the programs move into the order I wanted them to be in based on my gut reaction. After that I ditched the spreadsheet and just put them in the order that felt right to me.

I would also encourage you to put literally anything into the NRMP the day it opens just so that something is on the books in case you get put into a coma or get kidnapped until the deadline. You can always change things around after you certify, but you might find that putting in a list early and quickly is actually the least stressful way possible to do it.

In terms of actual program selection, there are probably a million factors that are unique to each applicant and to each program, so I imagine my reasons for choosing pediatrics at U Chicago are probably very different from someone choosing ortho at Rush, even though we’re in the same city. I’ll share with you some of the things I considered, just to give you a sense of my thought process.

  1. Program size and catchment. When I was applying to programs, I really thought I wanted to be in a medium-sized program and in a city that had only one children’s hospital. While interviewing I realized there was such a thing as too big, but there was also such a thing as too small and that shifted a few larger-than-medium programs higher up my list. I also realized it didn’t really matter to me if there were other children’s hospitals in the city, as long as we weren’t constantly shipping our patients out to them. There are a few really large children’s hospitals in the Chicagoland area, but ours is the only one on the South Side, so I’ve sent a grand total of 2 interesting patients to other hospitals for very specific indications.
  2. Location. I was terrified of Chicago when I came to interview, but had a great weekend touring the city and felt a pull to come here. It was nice to know that if I ended up hating it, it would only have been a 3 year commitment and then I’d have a definitive endpoint where I could leave without anyone being surprised or disappointed. It has been an excellent decision for me to have left my home state and I’m glad I didn’t stay in NC for training.
  3. Underserved population. If you don’t want to work with underserved patients, please please please be honest with yourself about this. I have interviewed numerous candidates here at U Chicago who really didn’t seem to get that taking care of children with disadvantaged backgrounds is a huge privilege and honor and should not be taken lightly. It is absolutely ok not to want to do that – everyone needs access to care, including the rich! Being in a hospital where our payor mix is 80% Medicaid/Medicare presents some unique challenges and is often not very glamorous. This is where my heart lies and I can’t really see myself doing anything else, but if that’s not you, don’t pick a program where you will not be happy just because it seems cool to say you take care of the underserved.
  4. Co-residents. I really enjoyed meeting the residents at almost every single program where I interviewed, but there was something about the “Comer family” that felt really right to me. They were a little less saccharine than the average pediatrician, and I felt like my sometimes-snarky commentary on life would fit in better here than anywhere else. I also really liked the program leadership here – most PDs gave a powerpoint about why we should choose their program and ours just had a really honest conversation with us. I loved that!
  5. Resident-driven program. I interviewed at a couple larger programs that were largely fellow-driven and could definitely see the appeal, but moreso the appeal for being a fellow there. I like that we have a mix of specialties with and without fellows here, but even on services that have fellows, it’s almost always the resident making decisions (with their support and teaching) and not the other way around. I have a ton of autonomy here and I absolutely love that, but if you want more supervision, consider a program where you are less likely to be making decisions on your own.

There were obviously many other factors that were probably more specific to my own goals and needs, but I hope there’s a pearl in there that someone might find useful when creating a rank list! Comment below if you have any other tips that a 4th year might need to know!

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