The Ides of Match!

16 03 2012

It’s Match Day!

Today, I had the privilege of attending the Match Day ceremony and celebration for the current 4th year students at our school.  Match Day is legitimately the most climactic experience that exists in medical education (yes, even bigger than graduation) because it’s when graduating 4th year medical students receive their first job offers and truly begin their careers as physicians.  This day is, for many, the culmination of everything that medical students have poured their academic efforts, heartaches, and often tears into for the past 4 years.

For those of you unfamiliar with how the residency match works, here’s a brief rundown:  It’s a lot like sorority recruitment.  Everybody fills out an application in like August or September of the previous year, send it to the programs to which they are applying, there’s a series of grueling interviews, then in February each student and each program create a “rank list.”  When a student and a program mutually rank each other highly, a match is made by a computer that determines where that student will be working the following year.  The Monday before match day, each student receives an e-mail that tells them whether they matched, but not where.    Literally, all the e-mail says are the words “Congratulations, you have matched.”  Or not.

What happens if you don’t match?  Well, when you’re done bawling, punching things, or emerge from shock, you do a condensed version of the primary process all over again, beginning that day.  It’s called the Supplemental Offer and Acceptance Program (SOAP).  So it’s another rank list composed of the remaining students and the remaining spots.  Followed by another, and another, and if you are one of those really unfortunate souls, another one until everyone is situated.  This is a change from last year, in which they utilized a process called the “Scramble.”  Which was pretty much what it sounded like.  The second a student found out that he or she didn’t match, the chaos of finding a list of programs that had spots, getting together and faxing transcripts or resumes, and making phone call after phone call began.  This process was still hectic and unimaginably stressful, and the spots filled more or less on a first-come, first-serve basis; though overall, I think it offered much less chance of repeat rejections.

The good news is that there is a spot in a US residency program for every US medical grad.  The bad news?  That spot is not always available in that student’s top-choice specialty.  For example, if you want a competitive specialty like Dermatology, Ortho, or Plastics, and you don’t match, you may wind up in an entirely different specialty that you really didn’t really want (typically family medicine or internal medicine).  If the entire reason for that student going to medical school in the first place was to do dermatology, that situation could be absolutely miserable.  Especially because submitting your match list is like potentially signing a 1-year contract with every one of those residency programs.  Which is why they tell you to never, ever rank a program that you wouldn’t want to work at.

Medicine is the most expensive known non-qualifying degree, which means that you can’t do diddly with an MD until after you’ve completed a residency training program.  Once loans start coming in after graduation, being in almost any residency program is better than none at all.  This fear of not matching anywhere is probably why students will still rank the program at EastJesus Nowhere as their #20 choice, even though they hate it, thinking they’ll never get it in a million years.  And yet, even in medicine, Murphy’s Law applies.

So by this morning, every student knew they had a match (and all of the ones who didn’t secure a spot in the primary match know where, and in what specialty, they will be training next year).  Every school has a different tradition for when, at noon, the match results are released.  Some schools gather every member of the class into one room, hand out the envelopes containing their fates, and everybody opens them at the same time.  Other schools, like mine, sit in an auditorium and call each student to the stage one by one to receive the results.  The students can either open their envelopes onstage or wait until they get back to the slightly-more-private environment of their own seats.  My school also doesn’t do things alphabetically, it’s all by random lottery, so you can’t even anticipate when your name will be called.  Many of the students went up onstage with their families or significant others, a couple even had cell phones with them, making international calls so that loved ones overseas could be among the first to know where they will spend the next 3-5 years.  They also had two cool maps on the stage—one of the state, one of the entire U.S.—so once their matches were revealed, they stuck pushpins on their future locations.  It was very exciting to see how widely my classmates would be dispersed come July, but also very strange to acknowledge that this class, some of my first role models in medical school, will in a very short span of time no longer be right around the corner.

It is very difficult to explain exactly how it felt to sit and watch the entirety of the Match Day ceremony from the sidelines.  While a small number of them already knew where they would be for residency—those in the military match and the unfortunate ones who didn’t get a spot in the primary match—the majority found out on stage, and everyone was able to witness their reactions.  And regardless of the considerable potential for devastation, their responses were overwhelmingly joyous.  Something like 85% matched into one of their top 2 programs.  Even if they didn’t, it was an immense relief for them to finally know where they will be after graduation.

It’s funny, because regardless of all of the statistics of success in the match (as long as you didn’t totally bomb medical school), and regardless of how frequently your academic advisors and clerkship directors and supervising attendings and peers tell you that you’ll match, even if your top choice is a program affiliated with your home med school (which traditionally give preference to their own students), even if you only apply to the least competitive specialties and the least competitive residency programs, every student’s fear of somehow not securing a residency position completely outweighs every statistic.  It’s comparable to people with a fear of flying; they insist on driving everywhere regardless of the fact that airline flights are, in reality, much safer.  If it is strong enough, fear and other extremes of emotional stress will outweigh logic every time.

I know the statistics.  I know that as long as I make smart choices as far as the residencies I apply to, I will match into a great program.  I know this now.  Ask me again in the months leading up to Match Day 2014 (I’m taking next year to get my MPH), and I won’t be so sure.  Despite my knowledge of the process and all of the odds, the pressure will likely start to gnaw away at my sanity and I, too, will succumb on some level to the paralyzing, sometimes sickening fear that somehow I won’t match (or won’t match at one of my top dozen or so choices).  It happens.

Right now, it’s more fun just to be thrilled for all of my classmates.  For all of these awesome people whom I’ve been able to call my friends and colleagues over the past few years, Match Day is the long-awaited realization of a dream that many have pursued since childhood.  This is probably the singular most exciting aspect of the entire experience.

I suppose that when my day comes it will feel the same for me.

I’ve still got a couple of years until I match myself, but for now, the glow of accomplishment radiating from all of the almost-doctors in the auditorium today has renewed  motivation to kick my butt into higher gear and to make the most of the remaining half of my medical school experience 🙂

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22 03 2012
Med School Odyssey

So. Far. Away.

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