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Friday Feb 10, 2017

Attention, Students: Six Thoughts Before Submitting Your Rank Order List

Tightness in your chest? Hyperventilation? Perioral paresthesias? The differential is limited: Acute twitterpation, or rank order lists for the National Resident Matching Program (NRMP), are due this month(www.nrmp.org).

I've spent four months out of each of the last four years involved in the application process. Here's what I've learned about how to rank residencies.

First and most important, any factors important to you are valid. There is no stupid reason for liking or disliking a residency program. Trust your gut. It got you through that premed mission trip to Mexico; it'll get you through this.

Second, there is no perfect program. The sooner you understand that, the happier you will be. See "the tyranny of choice(www.economist.com)" for splashy psychological proof. The basic idea is that when you realize that absolute perfection is impossible (excepting ice cream and sweet potato fries), you will be happy with a residency that is nearly perfect.

Third, don't focus too much on things that matter only a little. The majority of my medical school classmates had Excel spreadsheets with home-grown scoring systems and a minimum of 30 columns. As an overachiever, mine had 31. After too many nights trying to decide whether "mini-golf course quality" or "more bald people to blend in with" deserved the higher modifier, I realized that, for me, there were five things that mattered most:

  • public health training and experience;
  • rural family medicine training and scope;
  • incredible and accessible outdoor recreation;
  • Spanish-speaking patients; and
  • proximity to family, as well as a resident community that felt like family.

After deciding to focus on these, I felt free. So find your five things that matter most.

Fourth, pay attention to program directors. They will be your mentors. They will be your moral, clinical and professional guides. They set the tone for the culture and character of your residency. If they inspired you, if you connected during your visit, if you want to be more like them or want to learn from them, that means a lot. If your interactions were less than inspiring, that also means a lot.

Fifth, sometimes a residency will be great, except … something. Maybe you have a partner who's worried about finding a job in that utterly-amazing-but-maybe-too-rural place. Whatever your "except … something" is, feel free to ask the residency for help. They know the barriers and have myriad ways to address them. See what they can do. At my residency, we frequently help partners connect to potential jobs even before rank lists are due.

Sixth -- and this might be the second-most important thing after trusting your gut -- find your people. From illnesses to starting a family to run-of-the mill exhaustion, your fellow residents will cover for you, listen to you, commiserate with you, inspire you, encourage you and help you heal. They are far and away the most important part of your well-being during residency. I cannot stress this enough.

There are other resources out there, from an app by the NRMP(www.nrmp.org) to the AAFP's Strolling through the Match guidance. 

That's it. That's what I wish I had known.

And if on Match Day, you don't get the residency you wanted, do this:

  • Remember three people who love you no matter what.
  • Trust the Match. It's a good process.
  • Trust yourself. You are tough, you are in a beautiful and amazing specialty, and you can find joy wherever you land.

Stewart Decker, M.D., is the resident member of the AAFP Board of Directors.

Posted at 09:00AM Feb 10, 2017 by Stewart Decker, M.D.

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