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Mar 17, 2009

A Match Tutorial

It has come to my attention that not everyone knows everything about my life. Like the saying – or website name – goes, you’ll never know everything, so I guess I shouldn’t assume that everyone does. Sorry about that.

Let me explain the Match. This is one of those weird, screwball things that is so ingrained in the brains of doctors-to-be that it seems impossible that anyone alive hasn’t heard of this. So, for those of you following along at home who are lucky enough to have a life and career outside of medicine, let me fill you in.

The Match is the process that “matches up” residency training program spots and applicants. The applicants are mostly 4th year medical students, but also include people switching specialties (hi, Patrick!), people who went to medical school out of the US, or people who took time off between medical school and residency.

Residency is the training after medical school that is specific to whatever specialty the applicant/student has picked. Though all you need to be a “doctor” is a degree from a medical school, you don’t actually know anything yet and can’t legally do anything unsupervised for another few years. Residencies are different lengths depending on what the specialty is; Family practice is 3 years, Neurosurgery is 7. They also vary in competitiveness; psychiatry is less competitive than ophthalmology. (Though I do not know why. You could not make me look at eyeballs all day. Not no way, not no how. I’d have nightmares every night of my life.)

Those are the players: the applicant and the program. Around August of the 4th year of med school, applicants start applying to programs. They send in the normal stuff: grades, personal statement, letters of recommendation, lots of money. The programs then review all that and invite some of the applicants for an interview. (This is usually when the freaking out starts in the applicants.) Much of November, December, and January is spent traveling the country interviewing at various programs. Up to this point, this is pretty standard.

Here’s where the medical field takes a turn for the wonky. After all the interviews are done, the applicants sit down with their information packets and decide the order that they liked the programs (and cities that the programs are in, etc). After much (MUCH) agonizing, they create a Rank List and upload it into a Big Computer in the Sky. Similarly, the programs sit down with all their applicant information and create their own Rank List, also submitted to the Big Computer in the Sky.

The Big Computer in the Sky chews on all this information for awhile. The algorithm gives preference to the applicant, trying to place all the applicants at their first choice program. However, if the applicant is not on the program’s list, or are not high enough on the list, then the algorithm goes to the second choice program on the applicant’s list, and so on. None of the applicants or programs can do any negotiating or altering of the outcome here, it is all done by this algorithm in the Big Computer in the Sky.

The algorithm finishes, finally, and spits out everyone’s destiny. The Match constitutes a binding contract, so there is no trading around afterwards. However, as you might expect, not every applicant will match and not every program will fill its training spots. That’s why the Monday before “Match Day” is so important and terrifying. The applicants find out if they have matched. If yes, that means that they will have a job at one of the places on their Rank List, but they don’t know which one yet. If they didn’t match, then they will be given access to the list of programs that didn’t fill all of their residency spots. The applicant will then try to “Scramble” into one of those spots. It could be anywhere, it could be in a different specialty. That is terrifying, especially for someone with a family and a house. Thus, Monday’s “Did I Match? Yes!” email was a huge relief.

After the applicants who Scrambled have had a few days to try to find a job, everyone gathers for Match Day. This is always a Thursday, the third one in March, and is touted to be a huge celebration, but is actually the most nerve-wracking experience you will ever live through. The ceremony is different at every school. For example, at Patrick’s med school, they all opened their envelopes containing their match results together at noon and proceeded to freak out simultaneously. At my school, each person goes up on stage and opens their envelope in front of everyone and has a solo, spotlighted freak out. For Patrick and the other people who are not finishing school, there is no ceremony. Only a lone, much anticipated email around 1pm on Thursday, which will say, “Congrats! You’ve matched at _____!” Then, Patrick and I will breathe a sigh of relief, call our families and friends, and go about our lives, finally able to make plans for the future.

Now you’re all caught up and can freak out with me for the next few days.

7 Readers rock!:

barrie said...

Staying in Lexington is still a possibility right???

Katie said...

I'm glad you liked the muffins! It was so fun catching up with you. :) we'll have to do it again sometime!

Alykat said...

Yay, very informative; I'd heard people talk about matches in the veterinary world for residencies/internships and had a general idea, but now I get it! And it answered my one question which was, "How mean to tell you you have a job, and make you wait four days to find out where! Why would they do such a thing?" Now I know! I'll be thinking of you on Thursday!

barrie said...

But why can't they wait and do it all in one go? Is it to give people who didn't match four days for the "scramble"?

Katie! said...

Yep. The people who scramble have four days to find a job before the Match Day ceremonies. Then they get to announce their plans along with everyone else (and can even keep it secret if they want).

I think there is also a "this is the way we've always done it" quality to this whole thing, because no one in their right mind would do this on purpose.

Dragonfly said...

Oh my gosh, how awful if you opened your envelope on stage and didn't match. It would be kind of like when I got my high school results when I was holding a party for a friends 18th at my place and missed out on the cut off for undergraduate medicine by 1%. I.e messy. So glad Patrick matched though.

medaholic said...

I knew some fourth years who went unmatched at my school this year. You could definitely see dreams shattered that day.

Give 4th years a hug on match day.