How to Develop Your NRMP Rank Order List (2023)
/Strategies to optimize your rank order list and get into your dream residency program
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Part 1: Introduction
The road to becoming a physician is a notoriously long slog. If you’ve made it through four years of undergraduate study and four years of medical school, that means you’re finally closing in on that elusive MD. You’re now applying to residency programs and have hopefully interviewed with several that excite you. You’re probably aware that the next step at this point is to create your rank order list. If you’re finding yourself overwhelmed at the complexity of the process, you’re certainly not alone.
If you’re wondering how the rank order list works or how to approach creating your own, we’re here to help. In this guide, we’ll explain what the rank order list is and how it works, plus we’ll offer advice on how you should navigate choosing and ranking the residency programs that interest you for the best chances of receiving that desired match.
(Suggested reading: Residency Personal Statement: The Ultimate Guide)
What is the NRMP rank order list?
Your rank order list (ROL) is a list of medical residency programs, which you’ll create through the National Residency Matching Program (typically referred to as either the NRMP or The Match). Just as you create your list of preferred institutions, residency programs in turn create their own ranked lists of applicants they’ve interviewed.
The concept is fairly straightforward: if both parties have ranked each other, there is the possibility for a match to be made. This process is called the Main Residency Match.
ROLs are created electronically using the NRMP’s Registration, Ranking, and Results system, otherwise known as R3. Matches are then created using an algorithm based on the ranked choices expressed in the ROLs. The R3 algorithm works its way down an applicant’s list from first choice to last, meaning that, ideally, you should be matched at the program you most prefer so long as they have also ranked you and their slots have not been filled by higher-ranked applicants.
Adding a program to your ROL is a binding agreement, meaning that if a match comes through, you are committed to attending that residency program. As such, it’s important to make sure that the programs you include on your ROL will be a good fit for you. Backing out isn’t an option! That’s why you’ll need a sense of your priorities in a residency program. We’ll go over important factors to consider in a bit.
Primary vs. supplemental rank order lists
You can create two types of ROLs through the NRMP: primary and supplemental.
The residency match process has its own vocabulary, so here’s a quick reminder about the terminology:
Categorical programs are full residency programs designed to give you the training you need to attain board certification in your specialty.
Preliminary programs are one to two years long and provide generalized training concentrated in a specific area, such as surgery or internal medicine, after which you move into an advanced program in your specialty in order to complete your residency training.
A transitional year is a type of preliminary program in which you rotate through a wide variety of disciplines.
Primary ROLs can be used to rank categorical, preliminary, and advanced residency programs. Supplemental ROLs let you rank preliminary programs in a way that ties them to a specific advanced program.
All applicants will create a primary ROL regardless of which type(s) of programs they are ranking. However, if you’ve included advanced residency programs on your primary ROL, you’ll also need to create one or more supplemental ROLs to rank preliminary programs for your first year of training before you move into your advanced program.
If you match with an advanced residency program off of your primary ROL, the R3 system will then switch over to the corresponding supplemental ROL to match you with a preliminary program. This is designed to create the possibility of securing a full residency’s worth of training all at once.
Only those who are ranking advanced residency programs on their primary ROL will have the option to also create a supplemental ROL. Remember that categorical positions provide full residency training and don’t require preliminary programs, which is why you won’t need to also create a supplemental ROL if you are only ranking categorical programs.
How do you know if you should apply to categorical programs or a combination of preliminary and advanced programs? It largely depends on which specialty you’re trying to match into. Certain specialties, like anesthesiology, neurology, dermatology, and others, offer advanced programs, so if you’re hoping to enter one of these fields you’ll need to complete a preliminary or transitional year first. (Note: Some of these specialties may also offer categorical positions.)
However, the majority of specialties only offer categorical programs. Thus, most successful applicants—around 90 percent or so—wind up matching into categorical programs and only need to create primary ROLs.
What factors should you consider when developing your rank order list?
Creating a rank order list is a very personal and important step in your future career. No two ROLs will look the same, because no two individuals are the same. Nonetheless, there are some factors that you should consider when you’re ranking programs and developing your ROL. Those factors include:
Reputation: Perhaps one of the most important factors weighing on your mind as you create your own ROL is the reputation of each program. No one wants to be associated with a program that has a bad reputation—especially when that association has the potential to hinder your future job prospects! Carefully consider the reputation of the programs you’re interested in before adding them to your ROL and possibly creating a binding agreement to work in that program.
Location: Of course, location matters in more areas than just in real estate. When it comes to choosing a residency program, location can be a huge dealbreaker. If you don’t have any ties to a certain area and don’t intend to practice medicine in that region in the future, it might be best to forgo enrolling in a program in that region. It’s also worth noting that programs may prefer students who do have ties to the area, which may put you out of the running for consideration by that program’s director (PD).
Support: We listed this next because it’s closely related to location for many students. Without a strong support system surrounding you, you may not be able to reach your full potential. Your family and friends can often provide you with emotional and financial support, both of which you may need during your years in residency. As such, it would make little sense for you to enroll in a program that pulls you away from support that is so influential.
Culture: You’ll want to feel like you fit in well with the culture of whatever program you participate in, so make sure to do your research beforehand. While the program’s website is a great place to begin your search, you may find that other resources provide you with a greater understanding of the overall culture that exists within a program.
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Part 2: Step-by-step guide to developing your NRMP rank order list
In this section, we’ll provide a step-by-step timeline for how to create your rank order list, including deadlines for the 2023–2024 application cycle.
(Suggested reading: The Ideal ERAS Timeline)
Step 1: Register with the NRMP
The first thing you’ll need to do is register with the NRMP, which you can do beginning September 15th. In order to avoid late fees, you must register by January 31st at the latest. (Note: You can still register up until March 1st, but a $50 late fee will apply.)
Step 2: Create and certify your rank order list
Next, the NRMP will open on February 1st for ranking. You’ll then have until March 1st to create, complete, and certify your rank order list. To certify your ROL, you simply need to click on the “Certify List” button in the R3 system. Doing so means you’re entering a binding agreement to attend whichever program you match with.
Your rank order list must be certified by the March 1st deadline! If you haven’t done so, it will not be entered into the Main Residency Match system. (Note: You can still change your ROL after certifying it, so long as it’s still before the deadline; however, you must make sure to then re-certify it afterwards.)
Step 3: Match Week
The next phase of the ranking process occurs during “Match Week,” which is always the third week of March.
On Monday of Match Week (in 2023, this will fall on March 13th), you’ll get an email letting you know if you’ve matched but not yet where you’ve matched.
If you haven’t matched, you’ll be offered a chance to join a process called the Supplemental Offer and Acceptance Program (SOAP), which allows applicants who have not received a match to apply for unfilled spots at residency programs. In order to be eligible for SOAP, applicants must be registered for the Main Residency Match. Everyone gets an email the Friday before Match Week letting them know if they are eligible for SOAP.
Friday, March 17th, is the famous “Match Day,” when medical schools hold ceremonies for their graduating students. This is when you’ll finally learn where you’ve matched.
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Part 3: How to develop your rank order list
What guidelines should you use to create your rank order list? The answer to this question will differ for every person depending on their lifestyle and priorities.
Many future residents weigh personal priorities heavily in creating their ROL, such as location, proximity to partners or family, social fit, and happiness levels among current residents. (Note: If your spouse or partner is also applying to residencies, be sure to review our guide to the couples match.)
On the other hand, some are compelled by measurable program characteristics such as size, number of years of training, prestige, curriculum, and leadership or research opportunities.
We suggest that you make a list of the various elements that go into a residency experience and determine which ones are most important to you. Then, consider which programs you’ve interviewed with best demonstrate those qualities. Many current and former residents we’ve worked with recommend going with your gut sense of which programs will best contribute to you feeling happy, comfortable, and supported during the years to come.
The most important thing to understand about creating your ROL is that there is no “gaming” the system. Because the R3 algorithm works its way down your ROL—in other words, it attempts to match you with your highest-ranked program possible—you should rank the programs on your list in the true order of your preferences. Similarly, because matches are binding, you should not include any program on your ROL that you would be unhappy to be a part of.
However, there are strategies you can employ in creating your list and in determining how you rank the programs on it. Next, we’ll go over some key dos and don’ts to keep in mind as you create your ROL.
Rank order list strategies
Do:
Include a mix of more and less competitive programs, including at least one “safety,” to ensure a higher chance of receiving a match.
Rank at least several programs to create a higher chance of matching. We suggest ranking between 10 and 15. (Data from the 2017 Match showed that allopathic medical students who ranked 12 programs had a 95 percent chance of being matched.)
(Note: Certain highly competitive specialties, such as dermatology and surgical specialties, may require ranking more programs than our general recommendation above. For example, in 2020, applicants who successfully matched into residencies in vascular surgery ranked 17 programs, on average. If you hope to enter one of these competitive fields, we recommend conferring with a trusted advisor in your specialty as to the number of programs you should include on your ROL.)
Submit your ROL sooner rather than later. If you wait until the deadline, you run the risk of the system crashing as everyone tries to submit their ROLs at once.
Research different programs online using various outlets. Start with a program’s website, but feel free to also use online forums and social media to give you a complete picture.
Create a scoring system to compare programs on your own. Using the factors for consideration listed above—along with other factors you might want to include— rate each program on a scale of one to five. Then, calculate the total scores for each program to see which programs rank the highest. The benefit of this exercise is that you’ll be able to see how programs stack up in areas that matter the most to you.
Don’t:
Alter your ROL based on conversations you may have with residency program directors. If directors let you know that they plan to rank you highly, that’s wonderful. However, it doesn’t mean that the algorithm will necessarily match you to that program.
(Note: While it’s okay for programs to let you know how they plan to rank you, they are prohibited from asking you how you plan to rank them. Similarly, you may not ask a program what ranking you’ll receive from them.)
Rank programs where you didn’t interview. While it is technically possible to rank them, you should not do so because there is virtually no possibility of receiving a match.
Overlook important things that may slip through the cracks! Pay careful attention to all deadlines. It’s a good idea to set reminders or notifications in whatever calendar system you use to ensure you don’t forget important deadlines.
Finally, be aware that applicants are permitted to rank up to 20 programs on both their primary and supplemental ROLS before extra fees are due above the standard $85 registration. Any programs over this number will incur a fee of $30 per program.
Final thoughts
The pressure to receive a residency match is high for medical school graduates, and the hope to match at a well-fitting program is even higher. Creating a ROL may feel complicated, but following the advice in this guide will help you break the process down into understandable steps and leave you with the best chances of matching with a residency program where you’ll be happy and fulfilled.