Sunday 20 May 2012

program rank order list and implications for applicant

Buried in the depths of NRMP Data, I came across this very interesting piece of information. It deals with the number of applicants that the programs have to rank for the specialty to fill all the positions. So, what does this have to do with your match chances? Simply put the longer the list of applicants that the programs put up, the higher the chances of you matching. Now this is not the only factor and is a part of all factors that increase your chances of match success. This is easily an effect of inclusion, where more applicants are included in the list for that one spot. All things being equal and the numerical order set aside, the fact that you will feature on the list means that you will be called for an interview and therefore have a chance to work your magic at impressing the program and thus move up on the list.

Here is a simple example, for a hypothetical program A in specialty X suppose there is 1 position and they make a list of 1 applicant

1  prog -  app 1

In this case, there is 50 % chance that position will go unfilled, an outcome  which no program directors wants to face. But if the program is confident that the one applicant that have ranked is enough then their ROL will be 1 app. So assume he increases the program ROL to 2. now, the following happens.

1 prog        - app 1
                  - app 2

This scenario is interesting because if the applicant 1 decides to move away to another program, then applicant 2 moves in to the slot and gets the position. Thus

1 prog        - app 1 -->   program 2
<--  - app 2 (up)       

Now keep in mind this interpretation and data pertains to the program ROL and not the applicant ROL which has a completely different importance and implication in the residency algorithm. Thus, an increasing program ROL is a sign that programs are trying to safeguard against going unfilled. If the trend is towards increasing the program ROL, then more applicants are given a chance to participate in the match. For example if program 1 has 7 applicants for 1 spot on the ROL and in the succeeding year it increases the ROL to 14, then 7 more applicants have the chance to participate in the match. With this premise, let us see what the trend is for the specialties for ROL lengths. In order to do that a polynomial regression trendline was plotted for the the following specialties with emphasis on those that are favored by foreign medical graduates viz. Radiology (RAD), anesthesia (ANES), pediatrics (PEDS), categorical internal medicine (IM), family medicine (FM), neurology (NEURO) and pathology (PATHO). This is represented in figure 1 (below) which has the years on the X axis, and the length of the program rank order list (ROL) on the Y axis

Figure 1: projected trends of program ROLs

3 things are immediately apparent
  1. Programs that project an accelerated rising trend (radiology)
  2. Programs that maintain the current trend
    1. Static trend (anesthesia)
    2. Rising trend (peds, IM, FM and pathology)
  3. programs that project a declining trend (neurology)

The implications of a longer ROL by programs to include more ranked applicants to fill each position are two-fold, 1. They allow for more applicants to be ranked and 2. Increase the number of applicants interviewed in the succeeding year. Thus using the projections, it can be expected that more applicants will be interviewed for peds, IM, FM and pathology with the greatest increase in number of applicants interviewed and ranked in radiology. Anesthesia will likely remain the same and neurology will actually see a reduction in the number of projected interviews. In conclusion, the way things stand, neurology is going to get tougher, radiology easier that what it is and others will more or less stay on the current projected course. 

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  1. Hey. I have been reading your blog. Very interesting topics and thanks for everything. Concerning this topic, I was actually thinking that if there are more applicants, then it would be more difficult to match? Because you have more competition? But I do not have a good grip on this whole NRMP thing like you, so I might not be getting it.

    On the other hand, we are 2014 now, and I have heard that Radiology has become VERY difficult, especially for IMGs. Very competitive, and even more coveted than general surgery.

    1. Hi Alex, thanks for writing. I have compiled answer to your question with few other questions here

  2. the chances of getting ranked are higher doesn't necessarily imply that the chances of getting matched will be too. rather the probability to get ranked decreases as the prospective applicants increase


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