Thursday, January 28, 2010

the match

Oh my oh my! 2010 Match is upon us. For those of you that don't know, it's the gut-wrenching, terrifying process of trying to streamline/cram all 10-thousand something American medical school graduates into residency positions all over the country in all but a select few of the specialties. The idea seems ludicrous. The process begins as a 3rd year medical student (or before) when a medical student picks her specialty. Herein begins the compilation of board scores, grades, research, extracurricular activities, and letters of recommendation, not unlike any of the thousand other applications somebody with too much education has thrown together.

Not unlike any other CV compilation and job application, one applies and is invited for interviews. The BENEFIT of the match, and the ERAS (electronic residency application system or whatever), is that one CV is sufficient. No other essays, cover letters, nothing! And, applying is surprisingly affordable, comparing at least to medical school apps which were insanely expensive. It's something like 60 bucks for the initial fee, which includes 10 applications, then 10 dollars for each additional program, and after 20, then it's 12. Well, this part is cheap...just wait. The most fun part about the ERAS is that all of the programs are just a click away. Dreamed of moving to California? Well, click away! Thought you might want to build an igloo in Alaska as a family medicine resident? it's just one button. Click, click, click, click! Speaks one that only applied to 10 medical schools, I applied to 23 residency programs, even though I am probably way more qualified coming out of med school than into it. This makes it easy to OVER apply (as does the hysteria of the whole match process and the disbelief that you could possibly be as qualified as all those OTHER medical students at even FANCIER medical schools than yours).

Next comes the most stressful, or second most behind match, part. Awaiting interviews. You will get interviews. More than you thought. That's what everybody said to me, and I didn't believe them. Well, out of the 23 places I applied, I got 20. Way more than I could go on. And then you get to schedule them all. My medical school gives us tons of vacation time, so scheduling was only hard because I was going to various parts of the country and needed to try and get to them all in the middle of winter. Why?! WHY do they schedule interviews in the middle of blizzard season! This is not logical and adds to the stress AND fun of the whole process. I did not get stuck once. I am very lucky. Oklahoma had a blizzard this year. Nothing is guaranteed.

You buy plane tickets on your own dollar. What dollar? Yeah, who knows. Med school is expensive and demanding and demeaning, but you love it! You buy plane tickets and rental cars and call people you haven't seen for 5 years to sleep on their couch. You lose 15 lbs to fit into the suit you wore interviewing for medical school (or buy a new one). Then go! There's always a party the night before with Indian food, or so seemed the case for the obstetrical world this year, where there are residents and maybe faculty that want to "get to know you" (make sure you aren't really weird). The interview day is usually fairly long and at least 3 people will talk to you although at least in OB they want to pretend to be nice so most interviews are fairly relaxed. You'll get pretty good at talking about yourself. In fact, when you're done interviewing, you might be in a little you withdrawal.

Then, after smiling and asking the same STUPID questions 1000 times that you don't care about the answer to, eating way too many airplane peanuts, spitting a green bean over a chief resident, denting a resident's car at the dinner, almost missing your connecting flight in Vegas because you were playing the penny slots, and buying a plane ticket for the wrong day entirely and almost getting stuck in Atlanta, you're done. You make your rank list, write emails to your favorite people begging them to employ you, go on second looks if you have time/money/energy. And you're done! Phew. Wasn't that bad. Submit your list to NRMP or whatever the letters are... and certify it.

Here comes the sheer terror. The waiting. The hoping SOMEBODY liked you of the over 100 people you met enough to want to enslave you into the drudges of the hospital spending half of your life with your shoes soaked in blood and amniotic fluid. You spent about $3000 of your Uncle-Sam earned cash to land a job that pays 47 grand a year, which if you average over the 80 hour work week is about 10 bucks an hour. Yep! I'm honestly so excited.

The match seems like an archaic process. And guess what, it is! Only after a little of research, this excellent article published in JAMA (Roth, A. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912) discusses the history of the match process. It was first established in 1952: "That selection [of interns] has now been advanced on the school calendar to the beginning of the junior year and, indeed, inquiries now come to me even from sophomores. The dates of examinations and selection have been pushed farther and farther back, through the efforts of some hospitals to get ahead of others in the choice of candidates, for hospitals can exercise pressure on the selected candidates by requiring acceptance of offers of internship at once or within a short time. The student’s dilemma is understandable; if the first offer of this kind comes from a hospital of his second or third choice, he loses out entirely if he declines and is not selected later by the hospital of his first choice" (Joseph Turner 1945). This presented a significant problem to both programs and applicants as they were not making informed decisions and there was too much pressure on medical students.

The current algorithm has been the same since 1952, with few minor changes including the couples match. The algorithm, which is well explained by the NMRP is in the applicants favor. HA! Finally. This is the other awesome thing about applying to residency. The programs, for the first and last time ever, do not have the upper hand. They can rank you and recruit you, but only YOU have the final say if you rank a program or not. Well, I guess this is always the case, but as little control as you have in the match process, the programs are just as terrified that they won't match. Remember, they need you! You are the future slaves of Hospital X, the pride and joy of the hospital that will do all the scut work for the attendings. You are a valuable asset.

Between now and match day, the computer does it's little beep beep beep, 0101010101111000, a little cinnamon, a little sugar, no cream, and concocts the match list for all the programs. Supposedly it takes mere seconds for the algorithm to run. That's why you have to wait 3 weeks. I swear it's just for the NRMP to f&*# with your head in their diabolical plan to control the minds of 15,000 doctors for just a few weeks of the year. And when it spits out the hospital of your dreams and prints it on a plain white piece of paper, this functions as a contract. WHY DID YOU APPLY TO ALASKA?! You thought it would be fun. You'll know soon enough.

Match day. This year it's March 18th. So, now I just have to wait. But as I tear that envelope open and read choice #13 on the letter and start crying, I'll still be employed. In the end, that's what matters. As long as I match, I get to be a doctor, take care of people, learn how to operate, and deliver babies.

The most amazing thing about medicine is that as much as it changes, it really is the same as it was in 1952. It's a bunch of neurotic 20 somethings, waiting for the opportunity to learn from the people before them. It's being taught a beloved and semi-secret set of skills and to seek knowledge. It's to take care of people and improve the health of those around them. It's an opportunity to be at the forefront of medicine, "in the trenches" as they say, and get your hands dirty, just like they did 50 years ago. Match day is nothing more than gaining a little control on something, like medicine, that nobody can truly control. And that little morsel of order in a world of complete chaos, blood, sweat, birth and death truly stands for what gets us (or at least me) out of bed everyday.

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