07 March 2007

As Match Day Approaches...

The residency interviews are over and you have submitted your Rank List to the NRMP. If you have been fortunate as I was, you have been guided along this process by more senior medical students and/or a good faculty advisor. In any event, at this point in the process, that is less than a week to the point where you find out if you have matched or not, you are nervous but excited; depressed but hopeful; and a couple of hundred other emotions that fit the situation of having your immediate future in the hands of a computer.

During your third year of medical school, as you moved through your clinical rotations, you should have been collecting your letters of recommendation from your clinical preceptors. At my medical school, these letters were sent to the Dean of Students for inclusion in your file and made available for you to designate when you filled out your ERAS application. (ERAS is Electronic Residency Application Service). It was up to you to ask for the letters and up to you to make sure that the letters were in your file by the appropriate deadlines.

I had the added advantage of making sure that my personal statement, CV and letters were done very early. I had to apply for one of my away-rotations which had an early deadline. This rotation application needed the exact same content as my residency application so I was done long before I needed to be done. My application for this away rotation netted me a full-scholarship to cover travel costs and housing costs at my rotation location. During third year, investigate some possible away rotations that have scholarships attached. This does cut down on expenses during travel season.

As Match Day approaches, there is a tendancy to listen to all kinds of rumors that abound. Some people will try to say that you need 15 interviews in order to insure a match. If you are a marginal applicant to a competitive speciality, you might need 50 and still not match. If you are limited by geography and have a solid relationship established with a program, you actually only need one interview especially if you are a strong candidate for that program.

If you do not match, the Monday before Match Day, you will receive an e-mail that lets you know that you did not match. If you find that you are the recipient of this e-mail, you should contact your Dean's office immediately and find out what services are going to be availble for you during the Scramble.

The Scramble allows unmatched applicants to apply to any unfilled positions in any programs across the United States. In order to receive the list, you have to be unmatched, and in order to make sure that you application is ready to be faxed or e-mailed to programs with openings, you need to have all of your materials. You can print out a copy of your ERAS CV but you will need copies of your Dean's Letter and LORs which you should be able to get at your Dean's office. In addition, you need to have copies of your USMLE score reports and you need a copy of your personal statement.

A great advantage of being in your Deans office is that there are usually plenty of phone lines and fax machines available for you. If a program has an opening, they usually notify Dean's offices and your Dean can speak directly to a program director on your behalf. In any event, scramble from your Dean's office if at all possible. You can also find plenty of great classmates to help you man the fax machine and speak to program directors for you. (I helped a couple of classmates scramble and thus I learned loads about the process). Another advantage of being in the Deans office is that the Dean gets the unfilled list 30 minutes before it is available to the unmatched candidates. This gives you a 30-minute head start on getting your materials loaded in the fax machine and ready to go at nooon.

If you matched, you have to wait another three days to find out where you have matched. This can be more unnerving than finding finding out that you didn't match. On Match Day, many people have so much emotion pent up that they end up crying or depressed. I can tell you that as soon as you find out where you are going, you need to start looking for a place to live unless you have interviewed at places in the same location as your medical school and know that you don't have to move.

My medical school held a Long White Coat Ceremony on Match Day. On that day, we all received letters that told us where we would be going. At noon, we could open those letters and thus, we waited until everyone had letter in hand. We also received a Long White Coat with our names and the specialty that we had matched into. For some folks, they didn't know the specialty so they ended up with a nice long white coat that had their name and M.D. In any event, it was a great ceremony. We all open champagne and celebrated for the rest of the day. The first and second year students got the afternoon off so that they could participate in out fun too. I must say, that every year, I always enjoyed Match Day but I enjoyed it more when I was the "Matchee".

Match Day is a time of high emotions and expectations. It's far more charged than graduation day. On graduation day, everyone is just happy to have the whole situation over and done with. On Match Day, the anticipation is very high and we really do not know what to expect. The whole Match algorithm makes little sense and it is difficult to know why you ended up in the position that you ended up in. It's great to get your top choice but ask anyone who has scrambled and they will tell you that it is good to get any match at all. If you planned on going into a competitive specialty and found that you did not match, it can be pretty unsettling to end up in a preliminary position in a town or city that you did not plan to move to with the prospect of going back into the Match next year.

I have to say that going into the Match for fellowship is much better than residency. If I don't match into a fellowship, then I know for sure that I at least will be able to practice my specialty. It's a small victory but it's a victory.


David P said...


Just wondering if you ever ask yourself "what if I had matched somewhere else"?

Are there programs, in retrospect, you are glad you didn't match with? Or is there somewhere you wished you had landed?

Drnjbmd said...

The important thing to realize is that you do not have complete control over this process. You choose a speciality (usually over the course of third year), you apply to programs, some may or may not grant you interviews and then your choice is subject to a computer algorithm.

The one piece of advice that everyone is given, is DO NOT RANK ANY PLACE THAT YOU DO NOT WANT TO GO. The reason for this is that you MAY end up there. Other than that piece of advice, you are completely at the mercy of a computer.

Another consideration is that programs want to fill and thus, some program directors are less than honest with applicants. Every PD wants applicants to rank their program highly when in essence, not every program is a top fit for an applicant.

Do realize that most (but not all) residency programs are good programs. No program faculty and program director wants to be linked with a poor educational experience. Most faculty at most programs do their best to produce the finest residents possible to enter the workforce. There is LITTLE TO NO major difference between most residency programs other than particular specialty and location. The quality of education is actually quite comparable.

Finally, most of the time, you have to go on "gut feeling" to spot a bad program. If you encounter a program that doesn't let you see the actual working conditions of residents or does not actually lets to speak to residents that you choose, you will likely be facing one of those few bad programs.

If a program isn't willing to discuss the call schedule or educational schedule, you are likely facing a bad program. It is always good to speak to some of the residents (at your medical school) in the specialty that you wish to enter. The interns (PGY-1) have the best information on interview conditions.

Talk to current fourth years who have just matched and see what their opinions of programs are. Residency interviews are job interviews with the training thrown in. Like job interviews, residency interviews give you a sense of good fit versus poor fit. It also is a good idea to know something about the program too.

Like a marriage, unless you are in a particular program, you can't know exactly what the experience is like. Also like marriage, "the grass can look greener on the other side of the fence " but it might turn out to be dying.

Anonymous said...

Match Day 2008. ABSOLUTELY List only places you ABSOLUTELY want. 95% of students received their 1st-3rd choices because the computer is focused on an end result allowing 95% of medical students to receive their 1st - 3rd choices. AOAs - high honors - awesome board scores - great interviews - reference endorsements incredibly positive - pleasing, personal and numerous feedback from programs interviewed - can EASILY be overridden by a computer trying to force all students to receive a 1st - 3rd choice. If you like one place 100% and 2nd place is 10%, only list one. If you like two places 100% and 3rd is 10%, only list two. If you are a strong contender and list three places, the chance of receiving a 3rd choice is almost guaranteed. Remember, you will compete against strong contenders who only list 1 or 2 places and the computer is focused on the end result goal to show a high percent of students receiving their 1st - 3rd choices. The day before match day I was confident I would receive my 1st or 2nd choice. (Wonderful courting from my 2nd program choice.) My 3rd choice equated to a desire of about 10%. With hindsight, two choices would more likely have resulted in me receiving my 1st or 2nd choice. With hindsight, no matter how much a program courts you, if you have a 3rd choice, you will remain in the computer sort process longer than someone who only listed two programs. Play the game the way others play the game.

Natalya said...

Well said.