What should I consider when preparing my Match rank list?

When pondering your way forward in medicine — whether you’re a student considering which elective rotations to pursue or a mid-career physician thinking about changing jobs — it’s always a good idea to seek out the guidance of those who have come before you.

In this quarterly column, I answer questions from DOs and students about succeeding in medical school, residency and beyond. For this month, I am answering a DO’s question about what to consider regarding retirement and a student’s question about tips for preparing their Match rank order list.

A little about me: I’m the executive vice president and chief operating officer of the New York Institute of Technology (NYIT), where I also oversee NYIT’s College of Osteopathic Medicine. In my career, I’ve also served as a hospital chief medical officer, emergency department director, residency program director and emergency medicine physician.

I welcome questions from our DO and medical student community about anything related to success in medicine. Please send your questions to thedo@osteopathic.org. You can also reach me on Twitter @JerryBalentine and on Instagram @jerry.balentine. I look forward to engaging with you. 

“I know which specialty I want to pursue; when ranking my choices, what are some of the things I should consider?”

In general, I would divide this into medical-related and nonmedical-related considerations.

Medical considerations have mostly to do with the quality of the program, the program philosophy/intention and the “fit.”

Certainly, there are residency programs that are well-known in their specialties or the hospital they are based at is a nationally recognized name. This does not guarantee high quality but more than likely, it will at least have a few extra resources or help you with finding fellowships after residency. If you are considering going into a competitive fellowship after residency, you should also consider ranking programs higher that have this fellowship. Just make sure that the fellowship gives preference to their own residents rather than actively looking for residents from other places.

Programs usually make it clear what they hope their residents’ future careers will look like. Are they training residents to join an academic health care center or a community-based hospital? Do they emphasize ambulatory training or hospital-based practice? If you know what setting you want to practice in, this can become an important consideration. On the other hand, if you are not sure, don’t worry, all fully accredited residencies will provide you with great training.

Lastly, there is this question of “fit.” It might be a little bit more difficult to get a sense of, but often talking to residents gives you an idea of the residency climate. Is there a strong social component to the program’s philosophy? Are attending physicians approachable? How will you fit in with the residents, the physicians and the nursing staff?

Nonmedical issues include geography and personal life considerations.

If you know where you would like to practice in the future, it can be quite advantageous to rank programs higher that are close to where you would like to practice. You will be able to establish yourself in the local community and make professional contacts. You can also start getting a sense of the local practice environment and the reputations of the different medical groups and hospitals.

Obviously, sometimes this is also driven by personal considerations such as a spouse or partner who might be tied to a certain area by their job or other family considerations.

Whatever the circumstances you are considering, ultimately one of the really nice aspects of medicine is that you are quite mobile and even if residency brought you to an area where you don’t want to practice, there will be plenty of opportunities after your residency to relocate.

“I am thinking about retiring soon; is there anything I need to consider, such as my malpractice insurance or other medicine-related concerns?”

Retirement is obviously a big step in anyone’s life. Especially when your career (as for many physicians) has been an important part of your life and you identify yourself with that career. I will leave the financial aspects of retirement to you and your financial advisor.

One of the first aspects to consider when you are thinking about retirement are your future plans. While working long hours and taking care of the administrative aspects of your practice, stopping all of this seems like it could be quite a relief.

Just be reminded that this has been your life for many years. Discussing with your group or employer an arrangement in which you work part-time could be a very appealing way to ease into this transition. If you are in a private practice, maybe take someone on who will take over the practice while you decrease your hours.

One of the interesting aspects of being a physician is that our skill set is always in demand. So, as you plan your retirement, there are multiple options of staying involved even if your current position does not allow you to go part-time. Consider volunteering at a health center or at local community events, establishing a free clinic at your local house of worship or consulting part-time for an insurance company.

On the other hand, you might be someone who has it all planned out and is ready to travel or babysit the grandchildren full-time. Good for you.  

Besides your financial health, it will be important for your previous work not to catch up with you. Make sure your employment contract/relationship is terminated appropriately. Your patients will need to be advised of you leaving the practice and reasonable accommodations need to be made for them to find a new provider and the transfer of their medical records. If you are in private practice, the medical records will need to be available to be accessed if requested by the patient.

Depending on the state and your malpractice company, there are several ways to assure that you will be protected from financial responsibilities during future lawsuits. If you carry occurrence malpractice insurance, that is usually all you will need.

Even if not, some malpractice companies will provide you with free insurance to cover you for any insurance claims arising from cases prior to your retirement. Usually, you will need to indicate that you will fully retire and not practice medicine even on a voluntary basis. If none of these apply to you, you might be forced to buy insurance (tail coverage). The amount and length needed will be based on your state requirements and I would recommend discussing it with your local malpractice provider.

Although the cost of keeping your license registered can be significant, I usually recommend keeping it active for a few years until you are absolutely sure that you will not practice medicine. It is much more difficult to re-apply for a medical license than it is to keep your license active.

Related reading:

How will taking a year off of medical school impact my Match prospects?

Physician leadership: How do I move from practicing medicine into an administrative role?