Post-game: The CaRMS Rank List

In CaRMS Guide, Mentorship by Brent Thoma22 Comments

In the final post of the trilogy, I will be discussing the dreaded CaRMS rank list. If you haven’t already, I suggest that you review my previous posts on CaRMS – Pre-game: CaRMS Interview Preparation and Game Time: The CaRMS Interview – and checking out the full CaRMS Guide.

Following the interviews, you will likely be exhausted. Regardless, consideration of your rank-list should begin right away. After visiting multiple programs, often with the same group of applicants, one program starts to blending into the other, and the tour gets hazy. If you didn’t do so while you were traveling, consider making pro/con lists or some jot-notes about each program and city. At least get something down on paper while it’s still fresh – then you’ll have a few weeks to sweat over it, reconsider, and potentially make mood-induced changes!

Even after CaRMS interviews are over, there is a lot of “stuff” to do. Should you send a thank you note to the programs that interviewed you? How is the program going about making their CaRMS rank list? How should you go about making your CaRMS rank list? Should this change if you’re entering the couples match? And what really happens if the unthinkable occurs, and you go unmatched? This post will cover these topics and more.

Thank you notes

Some people feel strongly that you shouldn’t send thank you notes to the programs that interviewed you, and some feel strongly that you should. Among the latter, opinion is divided on whether they should go in the form of an e-mail or a card. Notably, the CaRMS rank lists for most programs are decided in a matter of hours after the interviews when everything is fresh, so I certainly don’t think whether you did or did not formally say thank you will raise or lower your stature on a rank list.

So send them if you like or if that’s your ‘style.’ If you were raised thinking that this is essential, then I wholeheartedly support that and hope my own little munchkin grows up to be as considerate as you. On the other hand, don’t sweat it if you are not inclined to send anything. Realistically, the programs are trying to recruit the best applicants, and you just spent your hard-earned money (errr… line of credit) to travel there for an interview. I think we’re as obligated to thank you for coming as you are for giving you an interview!

Program CaRMS Rank Lists

So how do programs make their rank-lists?

This will vary from program to program, but from what I’ve seen and heard it goes something like this: Generally, everyone involved in the interview process (interviewers, tour guides, hang-out room residents, etc) get together. Each of the interviewers ranks the applicants independently based on their subjective opinions of applications, personal letters, reference letters, and interviews. Those rankings are combined to sort applicants quantitatively. Then the discussion begins.

What does everyone think? Does it make sense? What happened with the outliers? (Applicants ranked disproportionately high or low by one interviewer or room of interviewers.) What do the residents think? Who would be a fit for the program? Any input from the admin support? Did anyone stick out as being particularly difficult to work with? (No one wants to match someone that’s a jerk to the administrative folks.) This is the ‘qualitative’ aspect of the ranking and there is always debate. Most of the attention is paid to the top of the list because these are the applicants most likely to match. However, a consensus slowly develops that is often quite close to the initial quantitative list and the final CaRMS rank list is submitted by the PD.

Keep in mind that there is going to be a lot of variation on how this is done from program to program and specialty to specialty.

And contrary to what I have heard from applicants, the interview does matter a lot. Sure, we have some idea who the top applicants will be prior to the interview based on your applications, but nothing is decided, and a good interview can bump up as far as a bad one can drop you down.

Your CaRMS Rank List

While I hope that the rest of this post was informative for anyone going through CaRMS now/soon, this is the only part that matters because, after interviews are over, it is the only thing you can do that will affect the outcome. For a more detailed set of examples, check out the CaRMS site here. For a more general approach on how to decide which program is best to you, check out this great post by Nikita Joshi on ALiEM.

How should I rank?

While making decisions about a CaRMS rank list is incredibly difficult for an applicant, fortunately, it is extraordinarily simple. What program/city do you want to match to the most? Make that #1. How about 2nd most? That’s #2. This process continues. That is as complicated as it needs to be. Please IGNORE anyone that tries to tell you anything different because they do not know what they are talking about!!

I used to think that this was self-evident. However, I frequently speak to med students that seem to think they can out-smart the system somehow by ranking highly the programs that liked them the most. This is wrong and demonstrates a lack of understanding of the CaRMS process.

I will explain why, but before I do, I hope you can promise me that no matter what anyone tells you, you will not do this. The most likely result of this ignorant strategy is that you will end up somewhere that you do not want to be just because they seemed like they liked you. There is no “like” in CaRMS, there is a match or there isn’t.

Why should I rank like that?

CaRMS uses a seemingly complicated algorithm to do something very simple: match each applicant to the program that they rank highest on their CaRMS rank list that has a spot available for them. It favors the applicant in that it only considers the program’s preferences after the student’s.

Example 1: For example, say Winnipeg really likes you, so they ranked you number 1. You thought they were really great but wanted to go to Toronto more, so you ranked Winnipeg number 2. The only way that Winnipeg will match you is if Toronto fills all of their spots before they get to you on their CaRMS rank list. That is to say, you will only drop to your 2nd choice if you can not match to your 1st choice.

Example 2: Say you were silly. You really want to match to Toronto, but thought that Winnipeg liked you more. Due to a misguided belief that you would be more likely to match if you rank the schools that like you more higher, or a desire to match to a school that likes you (everyone likes to be wanted, right?) you rank Winnipeg 1st and Toronto 2nd. Because Winnipeg did, in fact, like you (they ranked you #1), you will match there no matter what. Even if you were wrong about how much Toronto liked you, and they also ranked you #1, you would still match to Winnipeg because it was your 1st choice. Toronto would then move to the next person on its list, and you would move to Winnipeg, even if you had really wanted to be in Toronto.

Again: there is no “like” in CaRMS, there is a match or there isn’t. Remember that no matter where you match, they will be happy they matched you, because they ranked you higher than anyone else they could have gotten.

Your Couples Match CaRMS Rank List

The couples match is a great thing. With the preponderance of medcest, keeping doctor couples together and happy is important and allowing this option in the match truly helps to do that. Some people might say that you shouldn’t couples match, especially if you’re trying to match to a competitive specialty, because it makes you less competitive. That is untrue. While it is more complicated, if you are willing to consider every option (some couples may not), you can have exactly the same chance of matching as you would if you matched independently. How so?

The key is that you can list as many combinations for matches as you want. Your top choices will likely be partner 1 and partner 2’s top choice specialty at each institution. Then you can rank different institutions that are near enough that you can still live together (ie Hamilton / Toronto), then you can rank institutions that would require you to live far away (ie Vancouver / Halifax). Finally, you can rank you and your partner at each institution that you interviewed at independently (ie Vancouver / Unmatched). If you rank every possible combination the chances of you matching are the same as if you matched independently, except you are much more likely to end up somewhere together.

Circumstances for some couples might preclude the option of living in far away cities. Children and/or marriage and/or various other conditions make this completely justifiable, but would increase the possibility of one member of the couple ultimately going unmatched that otherwise wouldn’t have. This would occur if, for example, the only program that would have taken partner 1 was UBC and the only program that would have taken partner 2 was Dalhousie, and that combination of the two of them was not ranked. Either UBC/Unmatched or Unmatched/Dalhousie would then end up being the match, depending on which was ranked higher.

Regardless, I think couples matching is the way to go for every medical couple in the same year. If they are willing to do long-distance for the sake of their careers, they can rank every possibility, so they are more likely to end up together but no more likely to be unmatched. If they are unwilling to part or try long distance, they can still rank the best options for their future together.

Going Unmatched

One last word of advice on your CaRMS rank list. Some students are inclined to not rank some of the programs that they interviewed at. In a way, this is okay. You certainly shouldn’t rank a program if you would absolutely not want to match to it. However, you should remember that every time you don’t rank a program, you are effectively saying that you would rather be unmatched than go there.

If that is the case, I wholeheartedly support you. However, before you do this, consider what you would do if you went unmatched. Would you take a year off and try again? Try to match into whatever is left in round 2?? And are those options preferable to one of the programs that you didn’t rank??? In most cases, they probably are not.

Transferring

If you go unmatched, can’t you just get into another program and transfer into the program you wanted?

Great question. This is a backup strategy for some students, especially those trying to match to a competitive specialty like Emergency, Plastics, Opthalmology, Dermatology, etc. Many have pulled it off, and it may be possible for you too, but it may not. Barriers to transfers include:

  • Residents that matched to Family Medicine generally only have 2 years of funding. This makes it difficult to acquire funding for an additional 2-4 years.
  • Funding for positions is generally provided by the provincial government, so it will not follow you if you want to change provinces.
  • Some programs have extra capacity, many do not. Some programs are hesitant to accept transfers for various reasons or refuse them outright. Just because they’ve taken transfers before doesn’t mean that they will continue to do so in the future.
  • All programs will take some time to consider transfer applicants. Many will say no, and they have every right to.
  • The program that you do match to may not be excited about the idea of having you transfer out.
  • If you didn’t match to your preferred specialty in CaRMS it may be because, unfortunately, the programs in that specialty didn’t want you in their program. It is always hard to tell if this was the case or if you just didn’t quite make the cut for the last spot because a program matched high on their rank list in your year.
  • Matching to a program with the intention of transferring out of them is generally considered uncool for multiple reasons that I’m sure you can conjure up yourself.

While transferring is a possibility that should be acknowledged, I don’t think matching with the intention of transferring is a great CaRMS strategy.

Conclusion

And this concludes my CaRMS interview trilogy. For the complete series, check out the CaRMS Guide. Thanks for reading!

Editor’s note: This article was originally published on January 20, 2013 on BoringEM. It was revised and republished on CanadiEM on January 28, 2016. It has since been updated by Kelly Lien & Brent Thoma and republished on January 10th, 2017. For more CaRMS advice, check out the complete CaRMS Guide. The next post in the CaRMS Guide series is Life after CaRMS.

Brent Thoma

Editor at CanadiEM
Dr. Brent Thoma is a medical educator, blogging geek, and trauma/emergency physician who works at the University of Saskatchewan College of Medicine. He founded BoringEM and is the CEO of CanadiEM.