Road to residency

Rules to rank by: Creating your NRMP Match rank order list

An attending physician and associate professor shares a few general rules to consider as students prepare to narrow down their lists.


The end of the residency application process is approaching. Hopefully, you have completed all the preparatory work (see The DO’s previous Match columns) and now you are ready to compile your Match rank list. Rank order list entry for the 2023 National Resident Matching Program (NRMP) Match opens on Feb. 1, 2023; the rank order list deadline is March 1, 2023. There are a few general rules that I recommend following as you prepare to narrow down your list.

Seek guidance

Seek the guidance of more experienced people such as current residents, attending physicians and mentors. Also, I suggest making a table to compare your top 10-20 programs. Suggestions for categories include number of hospital beds, number of attendings, number of residents, inclusion of a Veterans Administration hospital or anything you find important for choosing a particular program. Here’s a sample table I use for students pursuing a neurology residency.

Sample neurology residency program comparison table
Neurology residency programs: Factors to consider Program 1 Program 2 Program 3
Program name      
Total number of residents      
Total number of fellows      
Total number of faculty      
Adult hospital beds      
Level 1 Trauma Center      
Pediatric hospital beds      
VA hospital beds      
Other hospitals      
Number of pediatric residents      
Any DO residents      
Any DO attendings      

Focus on your top choices

I understand that in today’s environment, students will place many programs on their rank list, but it is important to focus on your top choices. In 2022, over three-quarters of DO graduates who matched into residency matched into one of their top three choices, according to the NRMP.

As highlighted in my table above, you may consider a program simply because they have a fellowship that you desire. Most fellowship programs look favorably on those who have done a residency at the same institution. Also consider the type of training you will receive at the residency program. Some programs are geared toward training residents for academics, including research, while others train for an outpatient career.

Consider personal and geographic factors

You may consider your personal life to be a major factor and rank accordingly or pursue the couples match. Other students are focused on geography for reasons such as family, friends and lifestyle. If you know that you want to practice medicine in a particular area, this will help you rank programs.

It is not easy to envision how all of these factors will come together over the span of the residency. You may find that once you get into a program, the location or hospital size does not matter. You can only make decisions using the best evidence that you have at this time.

For your top programs, you may want to delve deeper into the residency and/or hospital website to gather more information. In addition, you may want to email current residents to ask specific questions before making your final rank list.

Include programs where you rotated

As someone who previously was on a resident selection committee, one of the most important factors in deciding whether to rank a student was whether the student performed a rotation at the institution. The best way to evaluate a potential resident is to have them rotate on your service for a month and have the input from the attending, residents and staff.

In terms of your own rank list, you should seriously consider placing the programs where you rotated at the top of your rank list. Even if you are planning to perform a rotation at a program in the future after sending in your rank list, you should include that program because they will have a chance to evaluate you in person.

Include ‘safe’ and backup programs

In addition to evaluating your top choices in your preferred specialty, remember to include other programs outside your primary specialty on your rank list. It is always wise to have a backup plan.

You may also want to include a “safe” program on your list. This could be a program where you rotated and they gave you excellent feedback or even offered you a residency spot unofficially.

Understand categorical, preliminary and advanced programs

Remember that the rank order list has two tiers. The primary list is for ranking categorical, preliminary or advanced programs. If you include an advanced position on your primary list, you will have to create a supplemental list. An example of an advanced program would be a neurology residency that begins in year two after a preliminary year in general training.

If you rank neurology programs on your primary list, you will also have to create a supplemental list for your year one general training. Some neurology residency programs have spots available in year one general training at the same institution if you match with that particular neurology residency program.

Exclude programs that don’t suit you

You may exclude certain programs from your rank list. For instance, you might leave out programs simply due to their location, such as those in particular states or urban areas. You may have had a particularly negative experience at a specific program and do not wish to rank the program even though you performed a rotation at the facility. You may speak with current residents in a program and decide that that particular program is not for you.

Be cautious regarding communication with programs

The NRMP allows for interviewers to extend a positive message to a candidate after the interview. Be cautious with this information. Ranking a program higher on your list exclusively based on this correspondence may be ill-advised. You can also consider sending a letter of intent to your top-choice program; this article covers those in more detail.

Other things to remember about the process

Also remember that the computer matching algorithm favors the student, so rank the programs in your preferred order instead of the order in which you think you are competitive.

Finally, make sure to prepare properly and ask for assistance and input from those who have navigated this process previously. On a practical note, enter your list sooner rather than later because you may encounter problems with the website.

Also, be prepared to be matched with any program on your rank list because the Match results are legally binding.

After you have done all your research and have discussed your rank list with others, trust your instincts and submit your list. Then try to relax and try to focus on your current rotation.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

7 tips on letters of intent for residency applications

Applying to residency: Tips for personal statements and letters of recommendation

Leave a comment Please see our comment policy