Given the time-sensitive nature of this post, I’ll be posting on Monday this week instead of Thursday.
It’s that time of year again, isn’t it?
Rank order lists for the CaRMS match are due this week, but I probably didn’t need to tell you that if you’re a final-year Canadian medical student hoping to secure a sweet residency position for July.
Some of you have already submitted your final ROL, no doubt, but if you’re one of the many who hasn’t yet hit ‘submit’, it’s probably because you’re still agonising over what can feel like the most momentous decision you’ve ever been asked to make.
Your list of options may be long, or it may be quite short. You may have a clear frontrunner program, or you may be fretting over what goes in that top spot. You may not even be sure which specialty you want to match to.
No matter what you’re experiencing at this point in the match process, someone else has been there before you. Thousands have survived, and you will, too. Knowing that may not help you make your match list, but here are a few strategies that might:
- Start at the beginning.To make a solid rank order list, you need to figure out what’s most important to you.
For some, geographic location is central to ranking. Perhaps your family lives in a particular city that you’re not willing to leave. Maybe your partner has a job that requires that he live in a particular town, or a place with certain characteristics, or an area that has a satellite location that he can work at. Some applicants have medical needs best met at a certain medical centre or by a specific physician or team.
For others, specialty is paramount. Maybe you really want to practice plastic surgery, and you’d rather do your training away from family, friends, and familiarity than miss out on the opportunity to practice what you love.
For some, yet other factors will be most important in the ranking process. Maybe you want a small program, a mid-sized one, or perhaps you’d prefer to train in a large centre. Maybe you don’t care exactly where you train, but you want to live somewhere you can afford to buy a house or condo. Maybe you want access to a ski hill, or a certain population for your clinical work or research, or an Olympic-sized pool, or a subspecialty centre of excellence.
It really doesn’t matter whether what’s important to you is important to the next applicant. What is imperative is that you sit down and make an inventory of what really matters to you in a residency program. Be honest with yourself, even if your list of important things seems silly. Don’t want to work somewhere that’s cold and dark all year? Someone else may think that’s kind of dumb, but you know it’s important to your wellbeing during what is sure to be a stressful time. Need to have access to a great restaurant or music scene? Someone else might not care about molecular gastronomy or underground hip hop, but you know you’ll be miserable without them.
- Rank according to what matters.
If training in a small centre is centrally important to you, ranking the country’s largest program in your chosen specialty as your first choice is counterproductive, even if it does have a reputation for being the most academically-rigorous or prestigious. Similarly, if it’s really important to you that you train in urology, it doesn’t make sense to limit your ranking by geography. If you need wide open spaces, training in Toronto might not be for you. If you love the hustle and bustle of a busy city, Brockville may not meet your needs.
Now that you have your list of priorities written, spend some time thinking about how each program meets your needs. No program is perfect, but try to imagine which program meets most of your most-important needs. Which program would fail to meet any of your really important criteria? Which needs could you defer for a couple of years if pressed? If you absolutely could not live with a particular program choice, strike it off your list and don’t look back. If a particular program fails to meet most of your important needs but you’d rather do your training there than go un-matched, keep it on the list.
- Don’t dissect your interviews. CaRMS is an applicant-proposing system, which means that you have the advantage in creating your ROL.
Don’t believe me? Yeah, for some reason nobody does, but there is no way to ‘game’ the system. Your best bet is to forget all about how your interviews went, or what you think a particular program is looking for, or whether the program director winked at you as you climbed into your cab to the airport, and just rank according to your own preference.
The algorithm will try to match you to your preferred program without regard to how you did on your interview, or how the program ranked you. As long as the program ranked you somewhere, and you ranked the program of your choice above all else, the algorithm will try to match you there.
It’s like this: Imagine you wanted to match to Saskatoon for radiology and there were only two spots (note: this is an entirely made-up example), and one other applicant wanted to match to Saskatoon radiology as well. If you both ranked the Saskatoon radiology program first, you’ll match there as long as the program put you somewhere on their rank list (i.e., did not black list you). On the other hand, if you really wanted Saskatoon radiology but you ranked it second because you thought you did better at your interview for family medicine in Yellowknife, you’ll match to Yellowknife family medicine before you match to Saskatoon, as long as there are available spots in Yellowknife. Some other schmuck will get your Saskatoon radiology spot, even if the program didn’t like them as much! See how you’ve screwed yourself over?
The only time a school’s rank list matters is if there are fewer spots than there are applicants who want those spots, and even then you still have the advantage. Imagine you really wanted to match to emergency medicine at McMaster. Say there are six spots and eight applicants ranked the program first on their ROLs. In that case, the CaRMS algorithm looks at the program’s ROL. Out of those 8 applicants, CaRMS will match the first six applicants on the program’s ROL to McMaster emergency medicine, even if they are, say, the program’s first, seventh, tenth, eleventh, twelfth, fifteenth, and twentieth choices. The CaRMS algorithm will then attempt to match the two remaining applicants to their second choice programs.
Seriously, it’s that easy.
The algorithm does not try to optimise program and applicant choices. It simply tries to match you to your top choice.
So don’t worry about how your interviews went. Just put your first choice first, your second choice second, and your last choice last.
- Talk to your non-medical friends and family.
In general, your non-medical friends and family will have absolutely no idea what the CaRMS process is all about (unless, I discovered, your non-medical friends are recent MBA grads, because apparently the CaRMS match is presented in MBA courses as an interesting anomaly in job-searching).
That doesn’t matter. Talk to them anyway.
Talking to your non-medical friends and family can help you put the whole CaRMS process into perspective, and can help you identify the true and imagined barriers to training in a particular specialty or at a specific site.
Often, friends and family know more about us than we do about ourselves, and that can be really helpful. You may think that you want to train in Ottawa, but your best friend may remind you how miserable you were there on elective. You may worry that if you move across the country you’ll never get to see your family and that they’ll be upset, but you may find out that they don’t expect to see you much during residency and that they’re willing to fly you in for Christmas and fly out to see you on your birthday.
When I was finishing my ROL, I was worried about where I would find mentorship and opportunities. One of my non-medical friends remarked that she knew that I was the sort of person who would find mentorship and opportunity no matter where I went, and she gently chided me for worrying so much about that part of the match process.
Spoiler alert: She was right.
- Forget about the competition.
Don’t worry about which program is perceived to be the most prestigious option. Don’t worry about what others will think if you decide you’d rather match to a program in your hometown than the biggest, shiniest program around. Don’t worry about how other people are ranking or whether your sworn enemy might end up at your site. You have no control over what other people think, feel, or do, so don’t even worry about it.
- Ask about the programs lower down your list.So, here’s the thing: You will probably match somewhere in your first couple of choices. You might instead match somewhere within your first handful of choices if you bombed an interview or two or you are applying to a competitive specialty. You might instead match to your tenth choice or your thirteenth or your twenty-seventh.
It’s not common, but sometimes people go way down their list. Sometimes candidates overestimate their competitiveness as applicants. Sometimes they have bad interviews. Sometimes programs decide that applicants aren’t a good match for their specialty, or for their program, or whatever. It doesn’t matter. What does matter is that you may go further down your list than you’d expect. You should be prepared for the possibility by making sure you have a list that is consistent all the way down to your last choice.
Many applicants obsess about which programs should go in their top few spots and don’t spend enough time thinking about the programs further down. Email the chief residents at your lower-choice programs. Peruse the programs’ websites. Think seriously about where you rank even your less-desired options.
After thirteen or fourteen interviews, I ranked twenty-six options (including multiple sites for some programs) when I made my ROL. I carefully chose my twelfth option as being more desirable than my thirteenth, and my twenty-fifth as being more desirable than my twenty-sixth. I left some programs or sites off my ROL altogether after deciding that I simply did not want to do my training there, and that I would rather go unmatched than match to those programs (Another huge decision. Truly make sure within yourself that you are prepared to go unmatched if you choose not to rank even one of your options).
Make sure that your ROL is consistent with your priorities all the way through to the bottom. Hopefully you’ll match to one of your top three choices, but prepare for the possibility that you could match to your eighth choice or your eighteenth choice and plan your ROL accordingly.
- Remember that nothing is forever.Your ROL seems like the hugest decision you’ll ever make. It’s not.
Of course, you want to match to the program that best meets your needs, and you want to plan to be in your program for the long haul. Still, you should know that residents switch amongst programs every year. It’s a hard process, and I’m sure every resident who switches wishes they could have avoided having to go through it, but it’s possible.
While it may be common knowledge that some residents switch to shorter, less-competitive programs (e.g., from neurosurgery to family medicine), I have also known residents to switch from shorter, less-competitive residencies to longer, more-competitive residencies, and even between the same specialties at different sites. Most switches happen within province, but I have also seen residents move to different provinces as part of a residency switch.
If you end up unhappy in your residency program, you may have the opportunity to switch. It’s an arduous process, but let it be a comfort to know that you are unlikely to be truly stuck, even if you don’t quite get what you want.
- Know that even if it is forever, you’ll make it work.Know what? Maybe you’ll match to your eightieth choice program. Maybe you’ll try to switch out and find you’re unsuccessful. Maybe you’ll grumble and groan and maybe you’ll cry. But, like so many people before you, you’ll figure out how to make it work. Residency is hard, but it’s time-limited, and you’re resilient. You can do this.
Now go submit that ROL.