DIP Episode 441 - How To Make A Rank List

Okay, welcome. My name is Divine. This is episode 441 of the Divine Intervention Podcasts. In this podcast, I'm going to be addressing the topic, how to make a ranked list. How to make a ranked list. Basically, I'm going to discuss factors you should consider in making a ranked list. First, I definitely really have a lot of podcasts I want to make very soon. It's just the timing that has been a little bit challenging for me, but I'm going to be rolling out a bunch of podcasts. There are some topics I want to complete. There's some high-youth things I want to discuss, so I'm going to hit those up pretty soon. But I figured since people are going to be submitting the ranked list soon, the match is coming up soon, it probably makes sense to go ahead and get this out. So again, please, this advice here, there are all my opinions. It doesn't necessarily mean that it's the right thing to do. Okay? So take every single thing with it. I'm saying with a grain of salt. I'm just seeing this based on experience. I'm based on what I think makes sense for most people. So what are some things you need to consider in no specific order when you're making your ranked list? Well, I'll try to see if I can discuss the most important ones at the beginning, but there's no real order to that. So the first thing is consider the program quality and then your quality of life. Actually, your quality of life probably over program quality. So I'm not single to an awful program.

I'm not single to a bad program. But I feel like one common mistake many medical students make is that they just focus on program quality, program name, program reputation. That's literally how they focus on quality of life. That's not a smart idea. The thing is by saying you're finishing like people that I met school and people that I know undergrad or people who are about to enter undergrad, we analyze many things in terms of what is the best of the best, what is the criminal crop. The thing is as you finish my school and start going for residency and you know, start working, you're beginning to go going to like the reality of life, the reality of the fact that you know what a residency after all is said and done, it's a job. It's a job you're supposed to do you're supposed to get paid for. So just kind of consider those things. Many people just look at quality they're like, oh, those are not the quality of life looks like whatever. No, I promise you when you start race is one of these things you may not believe, but when you start residency and you see how important quality of life could be to you, you start you'll be like, man, I wish I had made an alternative decision. So strongly consider quality of life. Basically pick the programs or un-cure the programs that provide decent quality of training, but also provide a very good quality of life. I'd rather go to a program that may not be the number one, right, in terms of summer and Ken out there.

It may not be the number one, but it has decent, ish training and offers pretty good quality of life. I'd rather do that than go to like the number number one, where I have this name badge that I went to this place, but in the end, I'm like suffering through every single week of residency. That's just the truth. That has always kind of been my philosophy on on residency selection. So just kind of be careful of that, you know, like for an internal medicine program, what is the deal with your weekends off? What's the X plus Y system? All those things kind of matter to be honest with you. All those things kind of matter. And I guess maybe a corner, a corner to this is don't leave your life based on rankings. Many people just leave their life based on rankings. Don't get me wrong. Again, you want to go to a higher ranked place, but at the end of the day, your success in life does not, is not fully determined by the quality of the place you go. It's most determined by the quality of the individual that you are. If a person goes to some ranking program that no one has ever heard of, what a person is a hard worker, the person is wise, the person is prudent, the person is committed, the person can be lifted to the very, very top of their field. So that's the thing. Something I've definitely noticed a lot in in many, you know, advanced countries. People are so ego slash. Rankine driven. They're so driven by those things.

It's almost like wow, if I don't go to the program that is ranked number one, if I don't go to this, if I don't go to that, my life is empty. No, don't draw your life fullness from some ranking that's middle by some person. Because again, yes, a person, a place may have great research funding and everything, but it may not necessarily make the most sense for your situation. That is just the truth. That is just the truth. Again, I see many people fix it so heavily on rankings and then they end up making decisions that they regretted long term. Don't be one of those people. Now, another thing that you should consider is just in terms of quality of life or just certain things, right? So like, for example, what are the program requirements? So there are some programs that don't have other than you like doing your job. They don't put too many onerous requirements on you. Just too many things that they're kind of making you do that you're like, man, this thing makes no sense, right? There are certain things you see programs do like certain model, certain practices, but if a person that is just on bias analyzes them, you're like, what is the point of doing this? This is a huge waste of my time. Those things can significantly impair residence quality of life. And don't underestimate the importance of having a good easy schedule. It can actually make it easy for you to study.

The thing is, many people think that they can learn everything about their field from just being in the hospital. That is not true. That is not true. To be honest with you, the uncertainty and specialties where there is absolutely not true. Like, for example, radiology, you need to study dermatology. I'm telling you, you absolutely need to study. So the thing is don't discount the importance of actually having enough time to just study. There are certain things, especially for your board exams, that you cannot learn or you will never see on the words. You learn those things, but actually like literally reading a book chapter on those things. And then another thing you should also consider is consider your past and your present situations. So consider like because many times a program may mirror a life situation you've been in before. So say for example, lessening your past and your present like your med school, like a very comfortable place, super highly competitive. And if you're like, oh, I like this kind of environment, I thrive in this kind of environment. Then you may be just fine in a residency program that mirrors that kind of environment. But if you know that man, a co-thruth environment calls me a lot of mental health troubles, a lot of mental health challenges. Why do you want to go to a residency program that literally mirrors that exact same thing? It may not be the best thing for your situation.

Again, the fact that a place is ranked number one doesn't mean that it makes the most sense for your particular life situation. And then another thing should also consider is the future. Is the future. What are your plans for the future? Are you going to get married? Are you going to have kids? Would it would be in a family environment? Fit well with the program's structure? Because you see some people they're like, oh, I want to go to the best ranked program. And then they are willing to sacrifice their families like my spouse doesn't matter, my kids doesn't matter. I want to go, they'll come along with me anywhere I go. Just be wise. Just be wise. Just be wise. Because the thing is if you saw your relationship with your support system, you're going to be feel a very alone in residency. Many people kind of underestimate the difficulty of residency. I'm telling you, especially in turn a year, you need all the support you can get. So if you burn every bridge possible, those bridges you've burned, you will not be able to take them back in the future. So I'll just encourage you. Support system is very important. Like, oh, do you have family closed by? I'm telling you, this is something that many people ignore. But it's like extremely important. It kind of boggles my mind when people don't consider closeness to family at all in their residency decision. They're like, oh, I want to go as far away from my family as possible.

Okay, that may be a thought now, but that may not be a thought when you have kids in residency. Because the thing is when you have kids in residency, you see with this COVID that kind of happened. It's really hard to get childcare and childcare is very expensive. Believe it or not, there's a pool that pay up to 3,000 or 4,000 a month just for childcare. Think about it. How much do you think residents are paid? Not very much beyond that. So just going to be wise about it. Like because many times, you know, if you have a family that you own family and they are willing to like take you over your kids while you have work, that can save you significant amounts of money. That can save you significant amounts of of pay. So I'm telling you, getting help from family can be very, very clutch in these situations. So it's very important to have a support system. I'm telling you, support system honestly should be for most people in my experience, the number one consideration in picking up, please, where they go for residency, the presence of some kind of support system. Many people do not think about it, but it ends up being like incredibly important. Don't underestimate the importance of it. For many people, I'm telling you this because I've advised many people on the around lists. I know many people that have become attendants, I know many people that have become residents.

I'm telling you in many situations, especially if you have a family already, it is more important than program quality. I can almost assure you of that. But again, like I said, I remember the disclaimer I gave at the beginning. And then I know that one thing should consider is what are your future plans. You want to go into academic medicine, you want to go into private practice. If you want to go into private practice, then honestly, the place you go doesn't necessarily matter. And actually, it may matter to an extent that you want to go to a place that gives you a lot of experience because in private practice, you're kind of on your own. You don't want to be the kind of person that is very slow at executing your tasks because believe it or not, in academic medical centers, especially in certain like very elite academic medical centers, there are so many fellowship programs, there are so many residents. So you may not be able to get adequate exposure to the kinds of things that will make you really stand out for private practice in the future. Right? You may notice that man, my person at this community program, my friends at this community, my other residents, I know this community program, well, they've done like 200 of this procedure by year two. But for you, because you're in a place and there's so much competition for that same procedure, you've only done 10. Believe it or not, these things happen. But again, these are things that people do not even consider.

So you just want to think about it. If you're going for an academic medical, if you're like, well, I want to go into academic medicine in the future. Again, nothing wrong with that. Try to go to an academic program. Try to go to an academic program. But again, you don't always have to go to the number one rank. I'm going to be very careful to mention any specific programs in this podcast, but you don't have to go to the number one program to be able to go into academic medicine in the future. No, right? In fact, just again, just be wise. Be wise when you're thinking private practice versus academic medicine, like ask yourself, because you see some people sometimes they almost like get brainwashed into saying, oh, if you went to this med school, you was going to academic medicine. No, it doesn't always mean that. Because let me tell you this, there's some very significant trade-offs you make when you're going to academic medicine as against going into private practice. There are definitely some very significant trade-offs because sometimes people almost drink like some Kool-Aid, like, oh, I'm a no-board doctor if I go into academic medicine. The thing is, you may feel very proud in your nobility, but don't forget that you're one missing out on pretty significant sums of money, and that money can make a big difference. I'm telling you at the end of the day, like, you can practice medicine forever. When do you want to retire?

A hundred thousand dollar a year difference in salary can be the difference between you retiring and having a very comfortable retirement, versus you retiring and not living particularly great, or you're retiring and still being in student debt. Don't forget that many people that come out from med school come out with loans, having that more money helps. So just kind of be careful. Just kind of be careful. Sometimes what looks very appealing, the reality of it is not what it is cracked up to be. Again, I'm not saying that don't go into academic medicine. No. For many people, academic medicine makes a lot of sense. Sometimes even in terms of the scheduling, it makes a lot of sense in everything. But sometimes in academic medicine, don't discount on the lower pay to all the politics you have to play, being in academic medicine, all the politics you have to play to get promoted, all the committees you have to be a member of, all the bureaucracy and rate tip you have to deal with. Again, many people kind of just ignore these things and say, well, I just want to go into academic medicine. Again, these are things that are probably more personal conversations. So I'm going to kind of kind of move on from that. But again, just kind of be consider those when you're picking a place. And then also look at the fellowship, their fellowship match and board pass rate.

For program has a really low board pass rate, compared to like many of the programs, that's probably a place you want to be wise about. Although to be honest with you, I wouldn't make that like the end or beyond. Because again, many times people like to blame the establishment for their own failures, but people sometimes don't look inwards. Sometimes the reason, actually, let me tell you this, many times, the reason that people don't perform well is because of their own personal characteristics. So people are just lazy. You think that everyone in Mexico is hardworking. That's actually not true. So you see some people that are like, oh, the didactics were poor, the thing is, that's not really a great excuse these days when there are so many good, both study resources out there. So, but again, you want to please that has good board pass rates because sometimes the place that we have poor board pass rates may just be because the program is just very grueling. So the residents have like no time to study at all. So just look at those things like fellowship, matrates, board pass rates, game, portance, but again, honestly, some people like put it as their number one. It should certainly not be the number one for most people. Now the next thing you should also consider are the values. Does the program jive with your values? Does the program jive with your values? Does the program jive with your values?

You know, if you're a person that has a certain orientation on life, then you go to a place that is just completely opposite of that. You may really struggle in that environment. So just ask yourself, is this a program that I've created my own personal values? Is it a program that I've created with how I see life? Is this a program that I've created how I approach life? Just make sure it's a place that can adjust your values. Now, one of the things you should consider are the people and the people, right? So who are the people that are in that program? Who are the people? If you see a program having a lot of their past residents working there as attendants, that can be a good indicator. Because if you had a bad experience at a place, you probably want to walk away as quickly as possible. But if a program like has a lot of residents in breeding, then it's probably like a good place. It's probably a place where people feel like, oh, wow, a residency was not enough. I want to stay here for many more decades of my life. You can really tell you, can really tell you something. And also just ask yourself, what was the program leadership like? I'm telling you, I've seen this in many residency programs. From any time the leadership can reflect the culture of the program. A program that has really bad leadership, don't be surprised. A lot of bad attendants, a lot of very toxic residents within that program.

Again, there's this saying that I hear a lot in my church that the leadership kind of flows from the head. What's the head of an organization like? Many times is going to reflect what most of the other people in that organization are like or how they do things. Again, it's not always true, but it's certainly true in many instances. And it also consider cost of living. That's another factor to consider. Are you going to be able to start paying off your student loans? Because I'm telling you that those three, four, five, six, seven years you're in a residency of fellowship, we're not paying student loans. Interest is just a crew. Interest is literally just a crew. And you know, don't count on income based repayment. There are very few people that have truly gotten that fit. Like to be honest with you, don't even consider that as part of your plans in saying, oh, this is how I'm going to pay off my student loans. No. So just look at the cost of living, right? The asserting parts of this of the US believe it or not, where you're paying rent and you rent it like four, five thousand dollars a month for like a one, two-bedroom apartment. So just be wise with that. Again, if you go to a place that has a low cost of living, you can pay off your student loans quicker. And then also enjoy a good life as a resident. Believe it or not, you may be able to buy a home as a resident on a resident salary. Although, before you buy a home as a resident, just be smart.

Some people they buy homes and then they want to sell it off when they're leaving. It may not be easy to sell off said home. Again, if you are a resident and you were selling off your home like a year, two years ago, no problem. But now, the housing market is taking a downturn. How easy will it be to sell off said home? For many people, it may not necessarily make sense to just buy a home, especially when you have all the debts already on your head like your met student loans, your undergrad loans and things like that. So just look at the cost of living again. Just ask yourself, can I literally afford to live in this place? That's something you really should consider. You don't want to be a person that is in residency and you're taking extra loans. It's kind of compounding your problems with debt in the future. Just something you want to keep in mind. And then again, location, location, location, location really, really matters. I'm telling you this location absolutely matters. Are you going to live close to family? Are you going to leave far away from family? Again, when you have breaks as a resident, we should be feeling far between. Are you want to go visit your family? Do you have to like travel, like through the high oceans, the might seas and everything to get to see your family? That's probably not the smartest thing to do. Again, I'm telling you, many of you that are thinking with your competitive mindset will not believe me on this.

But I promise you just give it three months in residence and you'll be like, man, the vine was really thinking through certain things when he said do X and do Y. I'm telling you this, do not, do not, do not discount the importance of a support system. No man is an island. Support systems really help. Right? Support systems really help. And again, in saying, oh, should I be close to your family? Also consider this. Sometimes there's nothing wrong with being in a program that's far away from family. If a program has like just a really, really good schedule. Because sometimes a program can have a really, can be really close to family, but the schedule is just absolutely awful. Although to be honest with you, being close to family is probably a more important, Trump in factoring almost every circumstance. In almost every circumstance. In almost every circumstance. But if a police has a really good schedule, but it's far away from family like it's a farer flight, it maybe is not the worst deal in the world because you may just have more breaks and more time flying time to go and visit to go and visit a family, to go and visit family. And you know, one thing I'll say about location is, many people are so hamstrung by location. They're like, oh, I can never live in this part of the country. The thing is to be honest with you, if you're in a situation where you don't have many programs where you didn't get many interviews, you really can be making those kinds of choices.

Beggars cannot really be choosers. So just kind of be wise. The thing is, in almost every circumstance, you cannot just to a place. Doesn't really matter how about a place is. Again, obviously, you want to go to a place you feel comfortable if you have that opportunity. But to be honest, with you, many people don't have that opportunity. In fact, I'm really hoping that in the future, I can talk about the state of the match. I try to do something that's mat related every every year. This cycle has some very unique oddities that honestly, I've probably never seen in any other cycle, I've never seen a CV in any other cycle. I will hopefully God willing kind of talk about it in a future podcast. But basically, what I would just say is, most people cannot just. Again, many times is not the place you are in. That matters. Is the kind of individual that you are. Is something that has always held very close to my heart. You can succeed in most places, even in a bad place. If you're just a person that is wise and has a certain constitution. But again, that's a conversation for another day. And then consider others in the picture. I've kind of talked about this already. Again, this is my own opinion. But again, look at the interests of other people in the situation. Like if you're married, consider your spouse. If you have kids, consider your kids. Again, the thing is, again, we live in a time in the world where many people are very selfish, very individualistic, very individualistic.

Again, many times in medicine, we appreciate decision-making. But we don't practice it with our own blood, with our own families. And that's not very smart. Again, because the thing is, if you choose a place and make every decision about residency, just to favor you. I'm telling you, your spouse may support you in the short run. But after a while, they will start feeling this content because they felt like none of their thoughts, none of the opinions, none of the things that they wanted to do, were considered in that circumstance. So again, I will just be careful, like consider other people. Because these are the people you're going to be counting on. And I promise you, you're going to need them. These are the people you're going to be counting on as your support system. Don't kind of kick them to the curb. Don't kind of throw them in the trash. That's not a smart thing to do. I'm telling you this. I mean, it's like just the principle of life in general. Don't just think of your own interest. Consider the interest of others. Not just in residency decisions, but in many other things you do. I just ask yourself, how I want to be treated in this situation, like the golden rule. Kind of applies in this, making a decision on where to go. It's always good to find a balance where it's like win-win. Try to find the win-win solution where it favors you, but it also favors your family. If people feel included in a decision, they will go to a bat for you when you move.

But if people felt like they were not included, they will not give much of any effort to try to help you in that situation. And then another factor to consider is didactics. Again, you don't want to go to a place that has truly bad didactics. You want to go to the place that has as good of didactics as possible. Again, I'm telling you this. If you can study well, which you probably can, if you went to med school, chances are the quality of the didactics should not be like a break-door die factor for you instead of 10 places. Now, there's this advice that goes out there. Only around places you can absolutely go to. Well, if you got like 40 interviews and you got like crazy high scores and you were like you're like a killer interviewer. Of course, you can follow that advice. But let me tell you this. If you're a person that didn't get many interviews, and to be honest with you, if you didn't train within the US following that advice is probably not smart. The process has gotten insanely competitive the cycle and it's going to get even worse with the upcoming cycle. The question you need to ask yourself is, can you live with not having a job for a year? And let me tell you this. The more times you participate in the match, the lower your chances of matching. This is something I've simply outmitted many, many times. Yes, don't get me wrong. Yeah, people have worked with one on one that tried once or twice didn't match and then boom, they finally did match.

What I'm telling you, if your goal is to have a job to be in the system, then you should rank every place you interview at. Because what's the point of intervening at 10 places? You only rank five because you're like, oh, the other five, I don't want to go there. And then you end up on match. I promise you the pain of being in that situation is worse than the pain of going to a place where you potentially did not want to be in the first place. Because again, it's much better to make moves when you're within the system of residency than when you are not. So I will strongly encourage you just be wise and prudent. And if you especially if you're in a situation where you didn't get me interviews, you better not be a trusser. Rank every place. Rank every place you interview that. Again, this may be a typical advice, but again, it's very practical and realistic advice. And many people I know kind of fall into these circumstances. And then next factor, and I'm almost done with this, don't make rankings based on what you were told. Program told me they're ranking me too much. That should not factor into your decision. Honestly, you should make rank lists based on where you want to go. The place that makes sense. Although, again, also just be wise. If you know you have like really poor scores, you're being interview very well out of place, but you're hoping for a miracle and put them number one, I kind of wish you all the best. Just be be smart and practical and wise.

If you know that, me and my scores are like really, really low for a place, I'd really do so well at this interview. Why would you want to rank them number one? And if you're crushed on much, they won't do much there. Chances are, if you have really poor scores for a place and you didn't really interview a lot of place, chances are pretty good. You will not match there. Again, it's not a curse. It's just reality. Again, at this time, situations have seen where people rank at places that we're far out of their league. Yes, but many times they were all the factors. You see people, they'll put their stories on social media that, ooh, I had two tens and two twenties on my exams. And I ended up matching at this crevice and the La Crab Program. Again, be careful of what you read online. Many people don't, we don't not tell you the full story. I've seen many situations where people, they will tell you what people want to, they tell you what you want to hear. But you'll selectively leave out pieces of information that end up being very critical. Like, ooh, maybe my dad knew the program director of this really elite program. And it didn't matter what my scores were. I was going to get in whether I liked it or not. So just kind of be prudent with that. Again, don't don't don't make your uncle's business. Don't watch some press and tell you or business on what you read online. Do like your literally your own original research. Do your own original research.

Now, the final thing I want to say again is very counter to a lot of popular wisdom out there is go with your head not with your heart. Go with your head not with your heart. Many people they make decisions of life with their hearts and then they end up ending in a pretty big ditch. Don't don't do that to yourself. Again, if you notice many of these role, many of these factors I'm saying to consider they are very practical, very, very practical. Don't be emotional in making a residency decision. Oh, what is the thing that feels right in my heart? To be honest with you, that whole concept of it feels right many times people have made decisions based on what felt right and you ended up kind of messing them up. Again, don't be emotionally in big life decisions. Be logical. Be practical in big life decisions. Like asking yourself, because the president that is very emotional about the whole process, maybe like, oh, I need to go to this number one program. If not, I won't feel good. I won't feel good if I don't go to this number one program. That's emotion speaking versus hmm, okay, well, there's this program is ranking number 15, but it's close to family. The schedule is very good. Cost of living in that place is very low. My spouse loves that place. My spouse can easily find a job in this place. Those are things you should all consider. That's logic. Use your head, not your heart. I'm telling you that common advice or follow your heart, I actually do not subscribe to it at all.

It's actually this part of the Bible, you know, many of you know, my Christian that says, there's a way that seems right to a man and the way is the end of it is death. There are many times in life where you felt really sure of something, but man, it end up as the way you want it to be. Even the Bible says that the heart of a man is deceitful and desperately wicked. So you want something that's deceitful and desperately wicked to be the thing that's literally guiding your decisions. I'm telling you, when you make decisions with emotion, you're going to make a lot of bad, bad, bad decisions. Use your head. Use logic. Look at things from a logical perspective. And in general, you end up making a lot of very good long term decisions. So I'm going to go ahead and pause here. Again, I really hope you find this podcast to be helpful. I imagine if I were a matchlion and then I heard something like this, it will certainly help me making a better, better decisions. So thank you for listening. Again, I offer review courses for all the USMN exams, step one, two, three, for bio statistics, social sciences, ethics, quality improvement, professionalism, communications and healthcare systems. I also offer a course for bio statistics. And I offer one on one tutoring and I help with residency applications, personal statements, the match and everything.

And then I have these podcasts on the major apps on Apple Podcasts, Google Podcasts, Spotify, I have a You Tube channel, Divine Intervention, USMN, podcast and videos. That's why I post the videos that I make and also post some podcasts on there. And I also have a new website called Divine Intervention Lifelesses.com. It's a Bible Base website and I post two podcasts every week that address some common life problems that people face from a biblical perspective. There's actually a podcast, as we share with that on Apple Podcasts, it's called The Divine Intervention Lifelesses Podcast. So thank you for joining me today. Have a wonderful rest of your day. I will see you in the next episode. Bye for now.

Quality of life and overall personal well-being.

The presence and strength of your support system (family/spouse).

Focusing too heavily on program quality, name, or ranking, neglecting personal life factors.

Academic medicine often means lower pay and more bureaucracy; private practice offers greater financial autonomy.

Interest accrues constantly, so do not rely on future income or repayment plans to cover interest payments.

Rank every single place interviewed at, rather than excluding those perceived as "below" their ideal choice.

Use your head and logic; do not make decisions based on emotion or what "feels right."

To ensure financial stability and ability to pay down student loans without incurring excessive debt.

Onerous or unnecessary program requirements, or an excessively poor schedule.

High-volume procedures and diverse exposure, as they will be practicing independently later.

Seeing many past residents working there as attendings or faculty members.

Their spouse and children (the entire support system).

Use your head and logic; do not make decisions based on emotion or what "feels right."

To ensure financial stability and ability to pay down student loans without incurring excessive debt.

Onerous or unnecessary program requirements, or an excessively poor schedule.

High-volume procedures and diverse exposure, as they will be practicing independently later.

Seeing many past residents working there as attendings or faculty members.

Their spouse and children (the entire support system).