Rank List

Post-game: The CaRMS Rank List

In CaRMS Guide, Mentorship by Brent Thoma15 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 – CaRMS Pregame: Preparing for the Interview and CaRMS Game Time: The Interviews – and checking out the CaRMS Guide.

Following the interviews you will likely be exhausted. Hopefully you have a few days before you go back to work. 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 make multiple 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

I am often asked whether or not applicants should send thank you notes to the programs that they interviewed at. Some seem to feel strongly that you shouldn’t, others that you should, and among the latter, opinion is divided on whether they should go in the form of an e-mail or a card.

Honestly, I don’t think it matters at all. I certainly don’t think whether you did or did not formally say thank you will raise or lower your stature on anyone’s rank list, and here’s why I’m confident about that: the CaRMS rank lists for most programs are decided in a matter of hours after the interviews. Nobody wants to meet again later. Everything is fresh in the minds of the interviewers that day, so we get it done then.

So send them if you like. If you were raised thinking that this is essential, then I wholeheartedly support that and hope that any spawn I happen to have are as considerate as you. On the other hand, don’t sweat it if you were not. 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. Just as you could thank us giving you an interview, we could thank you for coming.

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 and the applicants are sorted. Then the discussion begins.

What does everyone think? Does it make sense? What is up with the outliers? (Applicants ranked disproportionately high or low by one of the interviewers.) What do the residents think? (They are free to advocate for applicants.) Any input from the admin support? (No one wants to match someone that’s a jerk to the administrative folks.)

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. A consensus slowly develops 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.

Oh, and contrary to what I frequently hear, 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 you almost 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 and, for example, guarantee that they will match 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 them 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 Toronto.

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 wanted you more than the people below you in round 1 or taking their chances in round 2.

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). As you can see, 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 circumstances 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. 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 ranking 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, you have some cahunas and 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 letting you transfer out.
-If you didn’t match to your preferred specialty in CaRMS it may be because, unfortunately, they didn’t want you in their program.
-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 the fact that it is a possibility 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 post riginally posted on January 20, 2013 and was updated on January 28, 2016 as part of CanadiEM’s “Throwback Thursday” Series.

Brent Thoma
+ Brent Thoma is a medical educator, blogging geek, and emergency physician who works at the University of Saskatchewan College of Medicine as the EM Program Director and Director of Simulation. He founded BoringEM and is a senior editor / tech support / jack-of-all trades at CanadiEM.
Brent Thoma

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Helping good people to become great doctors. Study simulation and social media in #MedEd. Editor for https://t.co/nAiSSZlavk & https://t.co/7X8DQNihTw
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  • jean du rand

    Hi Brent. Thank you for your very informative reviews of the CaRMs process! I got great insight into the finer details regarding the matching process. Do you have any specific suggestions for IMG’s and/or couples matching?
    Regards Jean (CCA)

    • Jean,

      Good to hear from you!

      I had actually meant to discuss the couples match in this post, but it seems to have slipped my mind. I definitely have a rant on that – the post will be updated to include it very shortly.

      In regards to matching as an IMG, that’s a subject that I can not speak to with any authority as I have not been on either side of that process. While I expect a lot is the same, the paucity of positions, jurisdictional issues and return-of-service agreements mean that a lot is different and I wouldn’t want to speculate. However, I do think that with your previous training and CCA work you’d be a stellar candidate.

      Best of luck to you and your wife with whatever route you decide to take!

  • Gutterdoc

    Going unmatched is essentially career homicide. It’s the scarlet letter.

    I’m stuck in a shit specialty I hate, because I went unmatched and became a piece of shit.

    This tends to be the trend overall. If you go unmatched, its because there is something wrong with you. You just didn’t know your place.

    For instance, my place is in the gutter.

    • Hey,
      Sorry to hear that you’ve had such a horrible experience. I hope that you’re able to work past it and, if you really hate the career you’ve been dealt, manage to transfer or retrain.
      Going unmatched is a terrible experience, and unfortunately, it regularly happens to good people. Like most adversity, I think how you overcome it will be what really matters in 5-10 years. Don’t let it define you.
      Best of luck.

    • SuperNomad

      Hello,
      Sorry to hear that, but there is always a bright side to everything. IMGs go unmatched every year, and they would kill to be in your position now.
      There are no dead-ends, just hold it together and work your way through the system. Best of luck dude

  • Gutterdoc

    It already has defined me. Nobody wanted to give me a chance, nobody had faith that I could do a good job. The shit program I am rotting in just wants a call slave and some government funding. It has a reputation for being the worst program in the country. I can’t switch. This is what I am. Gutter trash.

    You have a good website. Keep it up. I could have used that kind of advice a few years ago. I hope it helps some people out. Don’t go unmatched. It’s the end of your career.

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  • GD

    Could you do a thing on how to gracefully quit residency?

    • Hmm… Sounds like you’re in a rough place. Do you mean quitting entirely and leaving medicine? Or transferring to another residency? The latter’s probably more challenging than the former, but it’d be sad to see either after you’ve put so much into this life.

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  • sting

    Do you think I should give a shot ranking programs that i like but they didn’t offer me an interview? (of course after those who interviewee me)

    • Brent Thoma

      I think it’s very unlikely that a program that didn’t interview you would put you on their rank list, but it wouldn’t hurt to rank them. If you are going to do that it still makes the most sense to rank programs in your order of preference (as outlined in the rationale above), regardless of who offered you an interview.

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