A Medical Student’s Rite of Passage
By PAULINE W. CHEN, M.D.
Published: March 19, 2009
Chitose Suzuki/Associated Press
Boston University medical students check letters together to find out where they have been accepted for their residency.
Since 1952, every third Thursday of March has been designated as Match Day, a day when graduating medical students in the United States open the envelopes that determine the rest of their careers. Like a dart thrown at a map, the note enclosed, or the password-protected Web site, holds the name of a single residency program somewhere in the country to which the medical student has been assigned. While medical school may lay the foundation of medical education, it is the residency training, completed in the years after graduation, that creates the practicing doctor.
For every senior medical student nationwide, Match Day is the culmination of years of work, months of applications and interviews, and weeks of wrangling over a final rank list. In mid-February, students submit their top picks to a central computer in Washington, D.C. At the same time, residency programs throughout the country submit their own lists, ranking candidates based on grades, interviews and recommendations. In the weeks leading to Match Day, the computer churns the tens of thousands of choices through a complicated matching algorithm, finally spitting out the name of a single residency program for each student.
Every doctor remembers his or her Match Day. Many of my classmates gathered in a Chicago bar, announcing their matches over a sound system usually reserved for local rock bands and slipping dollar bills into a kitty that would go to the last student to find out. I, however, chose to be alone. The possibility of failing, of either not matching at all or of matching at a program far from home or friends, haunted me for months beforehand, and I knew I couldn’t bear to shoulder my disappointment in front of 140 classmates. At noon that day, I slipped away from the lab where I was working into a small conference room. There I made my phone call, swallowing hard to keep my heart from leaping out of my chest.
It’s hard to forget the relief I felt hanging up the phone, or the sense of having transformed in a second’s time from undifferentiated medical student to surgeon. I had matched at Yale-New Haven Hospital, a program that was an hour’s drive from family. But in retrospect, I have come to realize that Match Day was more than an event to mark a residency assignment for me. It was a dramatic professional lesson: as exciting and fulfilling and personal as medicine could be, the system in which we would practice had the potential to dictate our future lives and the lives of those we loved.
While Match Day results came as the realization of a dream for me and for the majority of my peers, others saw the hopes of a lifetime vanish as soon as they opened their envelopes. On “Black Monday,” the Monday before Match Day, a handful of students learned they had not matched at all and had to scramble over the next three days ― calling programs, faxing transcripts, interviewing impromptu ― to secure a slot in whatever program would take them. An aspiring radiologist who had failed to match in radiology had to reconcile herself over the course of those three days to another field of medicine altogether, since that was the only program where she could secure a place.
Even for those who matched, however, the news could be sobering. I later heard that some classmates stormed out of the bar after opening their envelopes, and others began sobbing on stage. The spouse of a medical student had to turn down a plum job offer in one city in order to search for work in the city dictated by the computer. Several medical school couples who chose not to do a “couples match” and submit their lists together, found themselves with residencies slotted in different states and quietly began the process of breaking up. One student, distraught over his match results, eventually boycotted graduation.
Unable to negotiate their matches, my peers and their loved ones adjusted the only thing they could: their expectations.
This week I was reminded of that day while reading "Match Day" (St. Martin’s Press, 2009) by Brian Eule. In his book, Mr. Eule follows three young female doctors, one of whom eventually becomes his wife, from the spring of their last year of medical school through the spring of their first year of internship. Although the narratives revolve around Match Day, the story is really about how the system of training and practice affects the personal lives of the youngest doctors. The specific demands of medicine lead to a litany of issues each woman struggles with throughout the year. Will my training swallow me up? How do I cultivate meaningful relationships during my few hours off each week? Is it possible to be a resident and have a family?
Like the best of Hollywood awards ceremonies, this book’s hook may be what is in those little envelopes; but it’s the show that is riveting.
I called Mr. Eule after finishing the book and asked how he had come to focus on three women.
“When I looked at practicing physicians, the statistics were close to 75 percent male, and these male doctors of earlier generations had paved the way. But now there was a big change. My [then girlfriend] Stephanie’s class was about 50 percent women, as was true in medical school classes across the country. During residency these women would be at an age where many of their peers were thinking about family issues. I wanted to see specifically how these three women went through that balancing act.”
“Clearly, though,” he added, “there was a personal aspect to it. When Stephanie told me about the Match, I realized that this day and this process would have a big effect on our lives together. Suddenly all these things in our future were out of our control.”
I mentioned that over time, each of the women, as well as their classmates, seemed to relinquish a certain amount of control over their own lives. “That was one of my fascinations with the Match,” Mr. Eule said. “In medicine, you are dealing with people who really excelled in their academic career and who were used to being in control. But the Match was a lesson for them because clearly they do not have complete control.”
“There is some control,” he continued. “You give yourself a little more control if you know your field well, research the places you rank, and if you rank in the order you want. But at the last minute, when you turn in your rank list, you give up your control. There is no negotiation for you or for the people who are going with you. On Match Day you cannot compare acceptances and make a decision together. The computer gives you one residency program.”
I remembered that for my classmates and me, much of the stress of Match Day had to do with perceived differences between residency programs. Many of us had convinced ourselves that certain programs would train us well and others would render our lives miserable. I wondered if as an observer Mr. Eule thought there really was a difference between residency choices.
“I think the match absolutely makes a difference personally and professionally,” he said. “This is a crucial turning point in all aspects of medical students’ lives. They are going from student to professional; they are developing their own families. There are very different styles at every residency program. Some are supportive of families, some have women leaders, some are more old school, some are more negative. The training program influences what kind of doctors the students become, as well as their personal and professional balancing act. They also may end up settling in the same area since a lot of people end up practicing near where they did their residency.”
I asked Mr. Eule if after all his research he believed the Match worked. “I think for the most part it works because a high percentage of students get one of their top three choices. But just because it works doesn’t mean it is perfect. I can understand why the Match came about, but it sure does feel like an anxiety-producing process where students have to relinquish a lot of control over their own lives.”
Despite the personal challenges imposed by the medical system, the three young women in "Match Day" come out on the other end of a difficult year with their best ideals intact. Their matches might not have been perfect; but these women ― two of them the daughters of immigrants and the third the daughter of a single mother ― control what they can, and that is how they care for their patients.
“These women had deep emotions about their work that were clearly going to stay with them for their careers as doctors,” Mr. Eule said. “I was so impressed by how the three women really cared for their patients. And they did so while under such pressure and sleep deprivation and while having so much work that had to be done at once.
“It’s truly amazing to me that people can keep that human component.”
Join the discussion on the Well blog, "Match Day: Medical Students Learn Their Fate."
About the NRMP
The National Resident Matching Program (NRMP) is a private, not-for-profit corporation established in 1952 to provide a uniform date of appointment to positions in graduate medical education (GME). It is governed by its board of directors. Five medical/medical education organizations, one program director organization, and three medical student organizations nominate candidates for election to the board: the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), the Council of Medical Specialty Societies (CMSS), the Organization of Program Director Associations (OPDA), the AAMC Organization of Student Representatives, the American Medical Student Association (AMSA), and the AMA Medical Student Section. The board also selects one program director, three resident physicians, and one public member from at-large nominations. Each year, the NRMP conducts a residency match that is designed to optimize the rank ordered choices of students and program directors. In the third week of March, the results of the match are announced.
The NRMP is not an application processing service; rather, it provides an impartial venue for matching applicants' and programs' preferences for each other consistently. Each year, approximately 16,000 U.S. medical school students participate in the residency match. In addition, another 18,000 "independent" applicants compete for the approximately 25,000 available residency positions. Independent applicants include former graduates of U.S. medical schools, U.S. osteopathic students, Canadian students, and graduates of foreign medical schools.
In 2008, the NRMP enrolled 4,214 programs in the Match, which altogether offered 25,066 positions. A total of 35,956 applicants participated in the Match. Of those, 15,692 were 2008 graduates of accredited U.S. medical schools and 20,264 were independent applicants.
Specialties Matching Service
The NRMP also conducts matches for fellowship positions in 34 sub-specialties through its Specialties Matching Service. Those positions involve further training after completion of the initial residency program and lead to certification in a specialty (i.e., cardiology).
The fellowship matches are conducted throughout the year. Please verify each fellowship's respective Schedule of Dates.
Please contact the NRMP at (202) 862-6077 or 1-866-617-5834 if you have any further questions about fellowship matches.
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