DIP Episode 368 - Top Things To Consider When Making Your NRMP Rank List

Okay, welcome. My name is Divine. This is episode 368 of the Divine Intervention Podcasts. In today's podcast, we're going to be discussing what you should consider in creating your NRMP round list. So the thing is I'm not going to come here and tell you how to make your round list. I'm just giving you things you should think about. Again, I've worked with many different people, more people than I can count in this much process that I residents. Some of them I've unattended in right now. Again, I've worked with tons of people, been on admissions committee. I'm just going to talk based on my experiences. Again, please take everything I say with a grain of salt. It's just meant to help you and give you my opinions. I'm not telling you how to make your round list. So it may just be, I'll just basically go through some things I think you should consider. Then you'll make your decision based on those factors. I just feel like sometimes just having a little more information can help with making good quality decisions. And then if you're taking step two, secure step three, any time within the next month, having an MBME testing strategy scores on the 21st of February. And I have a 24-year review course taking place between the 22nd and the 25th of February. It's going to be taking place through Zoom. Again, I've had tons of people take these courses and done extremely well on the exams. Pretty much almost every ones that get emails from people.

I've had people have the scores improve 20 points, 30 points, 40 points after taking my course. And then having a USMELY Step 2 CK school in May, the first two weeks of May. Again, it's a school you're going to learn a ton. I've made separate podcasts on these things. I feel interested in more information. Just ship me an email through the website. I'll give you some more details. Okay. And Step 2 CK school has a 40-person cap on it. Okay. Now, what is the first principle you should keep in mind as you're creating your NRMP rank list? Well, the very first thing I'm sure you've heard this have known them. Don't make a rank list based on a program. I love your message. Right? The thing is, in general, don't trust anybody as you're going through the much process. Make rank list decisions based on where you want to go, not based on what a program has told you. Again, a program can tell you what you want to hear because they want to make sure that all their spots are filled, which you can blame them. Right? They're essentially acting in their best interests. Let me just tell you this. Many times you can blame them for this. Programs have to act in their best interests. In some situations, their best interests are your best interests. But a lot of the time, their best interests may not be your best interests. Now, principle number two, consider your credentials. Consider your credentials. Some people they're extremely unrealistic. Right?

The thing is, if your statistics are not competitive for a place you interview that, be very cautious about going all in on those kinds of places. Right? So if you know that you have like your like 20 points below average on step one and step two for a particular program, and then you have this hope and prayer, and then you rank them number one or whatever, I wish all the best. Right? Again, you need to be realistic. Right? You need to be realistic with distance. Now, what's the third principle? Again, I'm going to make this podcast very short and sweet. What's the third principle? In general, don't leave out any place from your rank list if you had a limited number of interviews. Right? You see some people they fall for this problem every year. They're like, oh, you know what? I interviewed a 10 places. Hmm? Of those 10 places, man, there's these two places I do not like at all. I would never go there. Right? But then again, they don't realize that the rank process is very competitive. And then the only rank eats. But they have true. Right? The thing is, you need to ask yourself a question. Are you willing to face the risk of not matching? Right? Or are you willing to, even if you get to a place you don't like, but at least you start earning some money as a physician? Right? Again, I'm just saying this. This is going to be a true top podcast. You've got to be realistic with yourself. Right?

Many people that I medicine went into significant debt to get to this level of applying for residency. Right? So again, trust me, the alternative of not matching is not ideal. And to be honest with you, when you don't match the first time, your chances of matching go down significantly as your participating future matches, right? It's just something you need to keep in mind. Although there are certain things you can do to adjust those probabilities, but that's not the topic of today's podcast. Now, what is principle number four? Well, look at program quality. Look at program quality. Right? The thing is, obviously, you want to go to the best program possible, giving the options you have. But one thing many people fail to learn in many, many cases is not the quality of your program that determines how good you are as an individual as an attendant. Right? It plays a role, but you also do have a role to play in how good you are. Right? The thing is, the key determinant for many people is your level of initiative, your desire to work hard, your dedication to excellence, your desire to learn. Right? So the thing is, you can go to a program with poor training, believe it or not, and still come out as an excellent resident. Again, at the end of the day, you need to start taking responsibility for your life. Right? So please, don't say, oh, the vine said, just go to any program. No, go to the best program that you can. But be the best resident you can be. Right?

If you want to become an excellent attendant in the future. Right? The thing is for many people, sometimes what they just need is a good, basic program. Right? Because many times, you know, you see some of these programs, they have all these bells and whistles, this special track, this specific kind of patient or specific patient population that you see. And then at the end of the day, when you're don't go in, when you're don't going through the residency program, you realize that man, this thing was not as important to my level of training. I didn't really need this. I could have just learned this on the much easier circumstances. Now, what is principle number five? Well, principle number five is, you know, look at how the program treated residents during the heights of COVID-19. Right? If a program treated residents with respect, treated them really well during COVID-19, that's like a very good litmus test for a program that's probably good. But if the program hung the residents out to dry during the COVID-19 pandemic, right? Then that's a program you should maybe think twice about ranking so highly. Right? The thing is, you can never know how good a person is until they are tested. Right? Until they go through a tough time, a challenging circumstance. Right? If a program treated residents like just absolute crap during the heights of the COVID-19 pandemic, then that may not be a program you want to go to. That's just a truth. Right?

A program that treated residents with decorum during the pandemic is a program you should consider strongly. Now, what is the next principle here? Look at quality of life. Right? The thing is, many people in making residency decisions, they just look at brand names. Right? Especially people that are high scores. Ooh, the brand name, the brand name. Don't get me wrong. There's nothing wrong with going to the brand name programs. I mean, it will certainly help your prospects for the future. Right? But the key thing I'll just say is try to avoid nervous breakdown institutions. Right? Try to avoid nervous breakdown institutions. Right? Again, the thing is, unfortunately, some people just have no choice. Right? They don't have the best stats. So they end up at these places. Right? But try to find the place that offers like the best combination of quality of life and excellent training. That is the middle ground you're trying to look for. Right? If a place has so many long call shifts and you have other options that have shorter shifts, go with the shorter shifts, please. Right? Go to a place that is well-staffed. Right? Again, I'm going to be very careful in some of my terminology here because, again, you just got to be careful in the world we live in today. But go to a place that is well-staffed. Right? Well-staffed not just with attendance, but also well-staffed with allied healthcare professionals like nurses, philbotomists, technicians and stuff. Right?

Again, you don't want to basically be the primary labor of a hospital. I'll say that again. You do not want to be the primary labor of a hospital as a resident if you can avoid it. Right? The hospital should be able to run without the residents being there. Right? If the hospital completely 100% absolutely positively depends on you to be there, you're going to be very likely going to a sweatshop. Right? So just be mindful of that. Right? Again, you don't want a place that falls apart if the residents are not around or not available. Right? Again, those kinds of places, the residents, very likely will have very negative experiences when exceptional circumstances like COVID-19 pandemic happens. Now, what is the next principle you should keep in mind? Support systems. Support systems. Right? Again, the thing is transitioning to a residency is not easy. It's doable, but it's also quite challenging. Right? The thing is, it's always helpful if you can be in situations where you're close to family or families like a direct flight away. Right? The thing is, vacations many times in a residency, if you have like a weekend. Right? They're not always the longest. Right? So you don't want to have to schedule two full days just to accommodate your travels if you can avoid that. Right? The thing is, this is probably even more pregnancy if you have like a family. Right? So let's say you're a resident and you have kids or whatever. Right?

If you have a family, it becomes very important because again, sometimes I'm telling you a residency, you need help with babysitting, you need help with food prep. Right? You need help with other things that other people can just help you with. If you have a support system in place, it's a lot easier to navigate those situations. Now, principle number eight is consider your long-term goals. Right? So what are your long-term goals? Are you interested in fellowships? Right? Well, are you interested in a particular region of the country for practice? The thing is, some people again, to be honest with you as a medical student, you have a very romanticized view of what medicine is. There's a really big difference between the thought or the idea of what medicine is and what the reality of medicine is. Again, as a person that has graduated from medical awhile back, I can tell you this, things that you don't think are important and have been very, very, very important. Right? The thing is, sometimes going to a residency program in the place you want to practice sets you up for a very, very, very nice job. Right? Because essentially you've been in the system, you're a non-quantity, people know you. Right? The thing is, in some disciplines, the area where you train for residency, just in terms of knowing the private practice groups and stuff in the area, right? Ends up moderating a lot more than even the name brand of the institution itself. Right?

So, the only thing is, if you're disciplines like anesthesia and radiology are very big with this. Right? Many people do things, if you're, again, they're crappy jobs in these disciplines, but they're also really good jobs. Right? You get the good jobs by word of mouth. Right? So, if, for example, you're like, you know what, I want to practice in this part of the country. It may not be a bad idea, especially if you don't have any significant circumstances that makes it a terrible decision for you. Being in that same general location is not the worst idea in the world. Right? And again, ask yourself, are you thinking of going into academic medicine or are you thinking of just going into private practice? If you're going into academic medicine, then you know, maybe looking at some of these ivory tower places may not be a bad idea. But, if you're going into like private practice, I don't know if it's the smartest idea in the world going to such an also academic place. Right? Again, just think of these goals be realistic with yourself. And then principle number in mind that you need to consider is the cost of living. Right? Again, the thing is many people don't think about this, but the cost of living in the place you go for residency is a very big determinant of your quality of life. Right? Some people don't even think about this. They're just like, ah, I want to end up on XYZ place. Again, I'm not going to mention any specific part of the country.

You all know the places that are very high cost of living. Right? But the thing is, if you can be in a position where you can start paying off your student loans in residency, it will set you forward financially in more ways than you could imagine. Right? So again, look at cost of living. Right? You don't want to be in a situation and I tell you that there are many people in this circumstance where you have to go into extra debt. Right? Because the money you're paid as a residence does not even cover the cost of living where you are. Right? So again, there are many good problems, not problems, many good programs in places that have reasonable costs of living. Now, principle number 10 you should consider is the availability of moonlighting. Right? The thing is again, if you are getting moonlighting income, it can help you quite significantly. Right? It can help you with paying off your student loans very quickly. Believe it or not, there are some people actually pay off their student loans before they even graduate from residency. Right? It can increase your income. Again, the thing is when you'd wait, let's say for example, you have a family in residency. Right? Um, you have like two, three kids, you're married and everything. Right? Trust me, those expenses add up very quickly. Right? Look at the program benefits. Today, cover step three, although to be honest with you, all these little perks don't matter as much as how good the program is.

If a program does you offer many perks, but it's a decent program that checks off many other boxes, I will choose that over a place that maybe offers like this very amazing book fund or whatever, but it's a terrible, terrible, terrible program. Right? Now, what is principle number 11 for procedural specialties? Look for a place where you can get good volume. Look for a place where you can get good volume. The thing is you can get good volume in places where there's not many much competition for cases. Right? So again, if a place has a ton of fellows, a ton of fellows, especially in that discipline that you're trying to get into, chances are you may not get as many cases as you want. You'll get enough because there are certain minimum requirements you have to meet for the ECGME to accredited program, but you may be struggling for cases with other people. Right? Or there are certain programs that have these other... Okay, divine, be careful here. They're programs that have these other training programs they run where they train certain, again, let me call this Allied Healthcare Professionals. Right? And sometimes those Allied Healthcare Professionals, they are training almost takes precedence over your training, your physician. Right? I'm going to leave it at that, but again, be mindful of those things when you're making your decisions. Principle number 12, if a place have had many of these last principles, a very quick principles. Right?

If a place has had tons of residents fired, you want to take notice. Right? If a place has just been firing, firing, firing so many residents, again, you want to try your best to rehabilitate a resident. But if you fire like one or two every few years, that's fine. But if they're firing multiple residents every year, that's the place you just want to think about. Right? Again, look at the program culture. Right? Or you see like in a program, so many residents seem to have almost like, let me call them bad circumstances happen to them. I'm just going to leave it at that. Right? Just again, if there's so much bad press, bad news around the program, there's probably like a good underlying reason behind that. The program may just not be taking care of your residents. And then principle number 13, submit your rank order list on time. You see some people they wait till like five minutes before things are due? That's not smart. The thing is there is tens of thousands of people trying to participate in the exact same process you're participating in. You don't want to leave your fate in the hands of servers that may not work as well as they show. Now principle number 14, don't share your rank list with people. Right? The thing is some people feel this great need to have your ego strokes that, ooh, I interview that there's Ivy League program, this top 10 program, blah, blah, blah, blah, no, don't share your rank list with people. I don't know why people do that. Right?

The thing is this is unfortunately a principle that has lost many people. Well, you need to be discreet in life. Right? Again, it's not being or like you can't be too cautious. Let me put it that way. Right? The thing is jealousy is a very powerful thing. And where do we find a lot of jealousy amongst people that are very high function. Right? So you need to be careful. Again, people may not, you don't want to give your, I don't know, you may just be surprised how people could torpedo your application. Again, I'm telling you where there is jealousy, where there is ambition. Again, even the Bible says that there is every evil work. Right? So again, just don't share your rank list with people. Right? Maybe like one or two trusted people that like, I don't know why people just feel this need to post their stuff online or mention stuff. Like again, I'm telling you, we live in a world where being as private as possible is the smartest thing you can do for yourself. Now principle number 15, right? Look at the number of sites you have to rotate through as a resident. Right? The thing is again, there are certain places where you have to rotate as like nine, ten different places that are 30 minutes from each other. If you can avoid those situations, the thing is clinical work in and of itself is already stressful. Right? And hospitals, unfortunately, don't always have the best parking situations. Right?

So you don't want to be in a situation where, or if you can avoid it or give it to a minimum, where you have to like drive to places because you have to get there at one, but then you, because of your clinical responsibilities, you get there at 1257 and then you're driving around for like 10 minutes to find parking. Right? Especially in a big city. That's a big, big deal killer at least for me personally. Right? And then ask yourself, how is the schedule of the hospital constructed again? Opinions, opinions vary. Right? But again, the thing is like, for example, in an internal medicine program, right? You want to try to have a situation where your impatient months are solely impatient months, and your outpatient months are solely outpatient months. That's what they call an Explosive-wise schedule. What do you mean? People don't think about that. Many internal medicine programs and to be honest, if you I don't think this is good, they have this thing where you do your clinical work in patient for like a few hours in the morning, talking to your patients, and then around two, you're going for clinic, and then you go see a bunch of patients, and then you come back stress to sign out around four or five. That's not ideal. The thing is, if you have like a full out patient month, then you can have golden weekends, and those golden weekends, you can use them to just enjoy time with your family, right? Enjoy your better quality of life.

Now principle number 16, be very wary of commentary from others, especially when you cannot verify it, right? The thing is you see some people, they make so many of their decisions based on what they read online. Let me tell you this, people lie, I'm telling you this, people literally lie. Some people can make a program look bad online because they want to improve their chances of getting into set program, right? But if many people are seeing the same negative thing about a program, that's probably a program you want to avoid. Now principle number 17, think of your spouse in making, in fact, this one, I'm not here to give you a relationship advice, I'm not a marriage counselor or anything like that, that is not my place. I'm just giving you some thoughts based on things I've seen. Think of your spouse when you're making decisions on residency, but consider the level of the relationship, right? Again, I feel very bad seeing this, but you see some people, they make all their decisions in light of some person, they met like two months ago that is the law of their life, right? And then somehow things don't work out and then that person breaks up with them, but then they sacrificed everything about their lives just because of this person in their lives, right? Again, you just need to be careful, right? So on the other end of the spectrum, right?

If the presence of your spouse, right, committed relationship stuff like that, you should certainly think about your family and not just yourself in making decisions, right? The thing is a win-win solution is the harder solution to find, many times, but it's the best solution. So again, when you're making these things decisions in light of relationships, just ask yourself, again, is this win-win, right? Try to balance the needs of the other, but also try to balance the needs of yourself. Don't lose everything, right? For, again, you know, you see people, you know, give you a hypothetical example, but you just met someone six weeks ago, you love this person so much. But then everything that matters to in a residency program, you're throwing that out the window because of a person that you've met six weeks ago. When you've been working on to get to this level for eight years, right? Again, just be mindful of that, but also don't be the person that wants your family to be the ones making all the sacrifice and you don't make a single sacrifice in and of yourself. No, that is not smart. Again, a good happy medium is always pretty. Now, principle 18, I have 19 principles. Principle 18 is program support, right? Again, the thing is it's always good to have a program that has systems in place to offload non-clinical activities that offer limited education to other people, right? There are programs that have like resident assistance that help with drafting IR Bs and calling consults.

Just things again that are not the most important from an educational perspective. You don't want to be the person doing those things, right? Like, for example, if there is a hospital that essentially makes you a phlobatist or makes you the transporter for your patients, that may be a hospital you want to avoid if you can. And then principle number 19, avoid special programs that are not useful for your future, right? The thing is, I don't know for whatever reason, mid students have this great love and desire for trucks. Oh, this program has this truck, this A truck, this B truck, this C truck, oh, da da da da da da da da da, you know, this truck will take an extra just six months or this truck will take an extra just one year. Hmm, this truck will take an extra three years. No, the thing is, many of these trucks end up being unimportant or extra degrees to be honest with you, end up being completely unimportant for your future. Again, there are some situations where it absolutely matters, especially if you're going into like heavy academia. But in many cases, it doesn't do much for your future. You're pretty much setting yourself back financially. The thing is, many people don't understand this. They look at it as a truck and yes, they're going to get some extra training. But many times, you're essentially just being extra cheap labor for a longer period of time than is necessary for the hospital, right? So be mindful of that.

So again, I really hope you find these principles to be helpful. Again, please, these are just my opinions. But again, I think it would give you some light or some clarity as you are making those decisions. Again, as I do at the end of every podcast, I do offer one on one for all the USMLA exams. Step one, step two, CK, step three, pre-clinical medical exams, 38-perchshipshoff exams. And then if you need help with your ERAS applications and stuff, I've worked with many people on those things. And I have these podcasts on all the major podcast apps, Apple Podcasts, Google Podcasts, Spotify. Just look for the Divine Intervention Podcasts and you can find those. I, you know, if, although on these podcasts apps, I can only disburs of the most recent 150. If you want everything from episode one to episode 368, which is this episode, then you should go on the website, Divine Intervention Podcasts.com. And then I have a You Tube channel, Divine Intervention, USMLA Podcasts and videos. Again, that's where I post the videos that I make. So just subscribe and whenever I make a video, right, you'll be able to see that. And then I also offer USMLA courses for step two, CK, step three, complex level two and three. Again, I have one this month. And then I have a school that is going to be running the first two weeks of May. I made a pretty detailed podcast on that, like maybe two, three podcasts ago. And then finally, I have a new website called Divine Intervention Lifelesses.com.

On that website, I go over just Bible-based teaching. Many of them, many of their little podcasts, they're like 10, 15 minutes long, that address like from a biblical perspective, the kinds of issues that humanity faces. So again, if you go to the website, Divine Intervention Lifelesses.com, you can find it. I also have the podcast on Apple Podcasts. It's called The Divine Intervention Life Lessons Podcast. So thank you for listening to me. Have a wonderful week. God bless you. Thank you. Bye.

Do not base it on what a program tells you; make decisions based on where you want to go.

How the program treated residents during the height of the COVID-19 pandemic.

The primary labor force; the hospital should be able to run without the residents being present (avoiding "sweatshop" environments).

It is a major determinant of quality of life and can prevent the resident from incurring unnecessary debt.

It significantly helps in paying off student loans quickly, potentially before graduation.

The specific geographic location where the resident plans to practice (especially for private practice).

Where you want to go/your personal goals, not what any single program recommends.

An "explosive-wise" schedule (dedicated outpatient months and dedicated inpatient months) to allow for predictable time off.

Special programs or extra degrees that are not useful for their future career goals, as they can lead to unnecessary debt/time commitment.

It suggests potential underlying issues with the program management or environment and should be noted.

1) Reasonable cost of living, and 2) Having a strong local support system (family proximity).

Increased competition for cases, potentially leading to insufficient volume.

Where you want to go/your personal goals, not what any single program recommends.

An "explosive-wise" schedule (dedicated outpatient months and dedicated inpatient months) to allow for predictable time off.

Special programs or extra degrees that are not useful for their future career goals, as they can lead to unnecessary debt/time commitment.

It suggests potential underlying issues with the program management or environment and should be noted.

1) Reasonable cost of living, and 2) Having a strong local support system (family proximity).

Increased competition for cases, potentially leading to insufficient volume.