Friday, October 26, 2012

How the NRMP Match algorithm works

Are you curious how the Nobel Prize-winning NRMP Match algorithm works? Here's my example highlighting the story of three students:

Students Alice, Ben, and Carlos apply to various numbers of IM programs through ERAS. Alice gets ten interviews, Ben gets zero, and Carlos gets two. Again, the NRMP has no idea how many. Alice has some good and some bad interviews, but decides to rank all programs. Ben ranks a dozen programs that he wants to go to, even though none of them interviewed him. Carlos only ranks one program (which happens to be a program that both Alice and Ben have ranked).

The IM program at Tufts will hire five residents, and ranks fifty applicants who interviewed there. Among other people, it ranks Alice at number 6, Carlos at number 14, and doesn't rank Ben at all (unsurprisingly since they didn't interview him). Alice ranked Tufts at number 4, Ben ranked it at number 2, and Carlos ranked it at number 1.

Match algorithm time. Ben has only ranked programs that don't have him on their lists. No matter how many he tries to rank, there's no possibility of a corresponding match, so he ends up unmatched.

The algorithm tries to match every applicant to their top choice and does not "count" how many programs they actually ranked. If an applicant's top choice has an open slot immediately, the match happens. Because Carlos has 13 people ahead of him at Tufts fighting for those five slots, there's no way that the first iteration will work for him. Alice also fails to match at her top choice (Harvard), and let's say that all of the spots there were instantly filled.

On the second algorithm iteration, Alice's top choice of Harvard is completely blocked. Her #2 choice (Stanford) automatically becomes her new #1...the program will not try to match her at Harvard again because it's impossible. It tries and failed to match her this time, but not all Stanford spots are full, so hope isn't lost yet. Concurrently, the algorithm tries to match Carlos to Tufts. He doesn't get matched this time either, but he's moved up to #12, since one person higher than him near the top of the Tufts list matched to her own top choice somewhere else. Interestingly, Alice is now at #5 on the Tufts list, which means the spot is potentially hers, but the algorithm hasn't tried matching her there yet.

A few algorithm iterations later, and Alice's second choice is full without her matching there, Tufts has matched three people out of five, and all of our heroes are still waiting...though it's just been a few microseconds.

A few more iterations and Alice's third choice (UCSF) is full. Carlos moved up a couple of spots. Tufts has matched its original first, second, and fourth choices, with the third matching elsewhere. Alice and the person originally in the ninth rank now have spots "held" for them due to the original fifth, seventh, and eighth on the list matching elsewhere, and the two of them moving up the ladder.

On the next iteration, Alice matches to Tufts. It's her fourth choice, but it was "virtually" her top choice since the three programs above it filled and she had no chance of matching there. She takes the fourth spot. 

A couple more iterations later and the fifth spot is filled (that man had ranked another program higher, and his spot at Tufts was "held" for him while that other match tried and failed to happen). Carlos is unmatched since Tufts was the only program he ranked. Interestingly, the other program he interviewed at had ranked him quite highly, and he would have matched there if he had bothered to rank it. Ben never had a chance of matching since he didn't interview and no programs ranked him. Both men can try to find a spot through the Scramble/SOAP.

And thus concludes a *very* realistic scenario. The NRMP has their own sample scenario on their website if you want to read it.

My congratulations go out to the creators of the current NRMP Match algorithm, who recently won the 2012 Nobel Prize in Economics! Click here for a short and accessible description of this achievement, and click here for the full journal article about the algorithm's history and development.

Friday, September 14, 2012

September 15 is not the ERAS application deadline!

September 15 is not the ERAS application deadline! Although it is the first day that you can send out your applications, you are not required to do so. Residency program directors will be downloading applications throughout the rest of the month until they can retrieve the MSPEs on October 1, and quite possibly even beyond that date.

What does this mean? Instead of submitting a poorly edited personal statement and an incomplete Common Application Form on the 15th, you should take the time to have your application professionally reviewed. Residency directors don't need your application immediately; they would prefer that you take your time and submit your best effort later this month.

I've been supporting medical students since January 2001, and I would be happy to share more than eleven years' worth of expertise with you. I will give you feedback on your personal statement and ERAS application, and if you'd like, I can go deeper and tell you how residency directors might react to your MSPE and letters of recommendation too. Please contact me for a free consultation. It's not too late to have the residency application you deserve!

Tuesday, July 31, 2012

Professional Memberships & Associations

One of my clients recently asked me whether joining professional groups could help her application. She also wanted to know if joining both the American College of Physicians and the American Academy of Family Physicians would help or hurt since they're focused on different specialties.

First, I think that it's most important to question why you are joining a group. Are you still in medical school and you want to learn more about residency in a certain profession? Great; you should definitely join! Are you a graduate who has decided on a field of interest and you want to interact with other professionals? That's another great reason to join.

Or are you only joining this group in order to list it on your CAF? If so, that is a bad reason and you might not want to do this at all. Padding your resume with groups that you've joined simply to impress program directors might actually cause you trouble. What would you do during an interview if someone asked you "Why did you join this group?" You'd have to say that you only joined to strengthen your application. That's not enough.

So before you join, think about what you can get out of these groups. Are you planning to attend conferences, read their journals, collaborate with or learn from members, make professional connections, and learn more about those fields? If you can honestly answer "yes" to some of those, and you will be able to comfortably describe your involvement if asked about it during an interview, then joining might be the right idea after all.

As for joining two different associations, remember that anything you list on your CAF will be seen by all programs you apply to, so FM programs will know that you joined the ACP, and IM programs will know that you joined the AAFP. Is that a bad thing? Not necessarily, since many people openly apply in both FM and IM, and both give you the potential to explore what it means to be a physician in a society increasingly concerned with primary care medicine. But if you're applying in both surgery and psychiatry, but don't want the program directors to know that you're doing that, then listing the American College of Surgeons and the American Psychiatric Association on your CAF might hurt you.

As always, please contact me directly, and I can discuss your specific application during a free consultation. There's no single answer to these questions or for any issues relating to your residency application; let me come up with a customized approach for you.

Saturday, June 30, 2012

The Residency Application Timeline

The 2012-2013 residency application cycle is about to begin! If you're applying for the first time, or even if you've gone through this process before, these are the crucial dates that you should be aware of. Please note that several of these dates have changed from previous years:

  • July 1, 2012ERAS opens its MyERAS website. First, you must request your login token (American medical students and graduates should talk to their deans; international graduates should use the ECFMG/OASIS site). After you register with your token, you can start editing your resume into the Common Application Form style used in ERAS, which not only means adding your educational and USMLE history, but more importantly means changing resume bullet points into full well-written paragraphs for each of your volunteer, work, leadership, and research experiences. You can also work on your personal statement, start requesting letters of recommendation (there's a form to print out for your writers), select programs and specialties, and much more. There's a lot to do and not very much time to accomplish it all, especially since you're studying for the USMLE, completing rotations or observerships, and worrying that your writing isn't as strong as it could be. You only get one chance to have your application make a great first impression! Many applicants realize that it's a great idea to find a residency support professional to help during this time. Please contact me for a free consultation.

  • September 1, 2012 – the NRMP website opens. The NRMP "Match" is processed separately from ERAS. Basically, you use ERAS to select where you hope to interview and to transmit your documents to those programs, but you use the NRMP to rank the programs where you actually get interviews so you can match there. You can save some money by registering for the NRMP early; while you don't need to register on September 1, the last day to register with a discount is November 30, 2012.

  • September 15, 2012 – this is the first day you can pay ERAS to transmit your application to residency programs. Many people will apply on this date, but it is not a deadline. It is much better to apply in late September with a fully reviewed and edited application, instead of sending something out with mistakes on September 15. (for those of you who applied last year, this is a later date!

  • October 1, 2012 – this is the date when your Medical Student Performance Evaluation (the MSPE, also called the "dean's letter") will be transmitted to all programs that you have paid ERAS for. When program directors download your MSPE, they will automatically download all other documents waiting for them, so you should ensure that your letters of recommendation and medical school transcript are in the system already. (for those of you who applied last year, this is an earlier date!)

  • November, December, and January – most interviews are scheduled during this time. Be prepared! Review your answers to common interview questions with a professional, and also ask that professional about the flaws in your application (such as failing the boards or taking a lot of time off) since the program directors will ask about those topics too. Even a great ERAS application means nothing if you don't succeed during the interview.

  • February 20, 2013 – this is the final deadline to register your rank list with the NRMP. You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program. You should rank the programs in the order that you hope to match to each one. Please read this for more information.

  • March 11, 2013 – this is the date when everyone who used the NRMP will find out *if* they matched, but not *where* they matched. If you are unmatched, you will be able to try to "Scramble" into open residency programs during this week.

  • March 15, 2013 – NRMP Match results are released, so people will finally find out exactly where they are going to be residents.

I know this is a lot to process, so please contact me for a free consultation and I'll help you!

Tuesday, February 21, 2012

Your NRMP rank list

Tomorrow is the deadline to submit and certify your final rank list with the NRMP. Here are the key points that you should be aware of:

1) You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program.

2) You should rank the programs in the order that you hope to match to each one. The NRMP algorithm is skewed in the applicant's favor; it will not hurt you to rank your favorite program first, even if you think you have no chance of matching there.

3) The rank list you submit and certify on the NRMP website is a binding commitment. If you match to a program on your list, that's where you're going.

4) The deadline for submitting and certifying your rank list to the NRMP is 9:00 PM Eastern time on February 22, 2012. However, I strongly suggest that you certify your list well in advance of that deadline. Power failures and bad Internet connections have caused trouble for applicants in the past, and if you don't meet that deadline, there is nothing that anyone can do for you.

UPDATE: Yesterday, I posted the text you see above, and today the NRMP website went down for over two hours (see screenshot below), but they did not change the final rank list deadline. Imagine if you had only set aside those two hours to work on your list!