Residency Interviews and Match Day

I’m always surprised by how people even in the medical field have no concept of how doctors interview for and decide where to go for residency.  

More accurately, we don’t really decide at all.  A computer decides for us.  The most complicated computer algorithm ever written.  In fact, the people who wrote it won a Nobel Prize in Economics for their work on stable allocations – basically the concept of the matching algorithm.  (described here)

During 3^rdyear (see my last post) we rotate through the general areas of medicine and decide what direction we want to go after graduation.  We then have to start applying to residency programs.   There is a clearinghouse application process and you choose which programs you’d like to apply to.  You’ve taken step 1 of the national board exam after 3^rdyear and have those scores as well as your 3^rdyear rotation grades and letters of recommendation from your attendings and professors thus far, and you write a personal statement.  You enter all this into an application program and submit it to the programs of your choice.  We were told to pick the quadrant of the country in which we thought we wanted to live and look at all the programs in that quadrant, narrowing them down by cities where we thought we’d want to live for 4 years.  It’s also common to end up working near where you do residency, so sometimes people choose to do residency where they think they’ll want to settle afterward.  

You request interviews from your selected programs.  You then wait to hear from them to be offered an interview.  If you are offered an interview, you have a list of dates they are interviewing and have to choose an available one.  You try to group programs together into trips to certain geographic areas if possible – I did a swing through NC and VA in one week long trip – to try to save money on travel expenses.  Keep in mind, you’re too busy with school to be gainfully employed while in medical school – many schools actually prohibit you from working while enrolled, and I don’t see how you’d have time to work while in school, especially in 3^rdand 4^thyear while on clinical rotations.  You’re paying for the privilege of working alongside residents and attendings to learn medicine.  Paying usually with borrowed money in the form of student loans, which also pay for your living and travel expenses (one reason why med school debt is such a big issue and we often end up with $200k or more in loans).  

You travel and interview at several programs between October and February of your 4^thyear.   How many interviews you do depends on the competitiveness of the field in which you want to train.  If you want to do a more obscure field (with fewer available slots) you may interview at many more programs than if you want to do a more common one with more available slots.  You go to that program and get a feel for what the attendings are like, the facilities, and the people you’ll be working with.  You look around the city and think about housing options.  You consider how close you may want to be to family.  If you’re thinking about an eventual fellowship already, you’d think about how many of their residents match into that fellowship. You’d look at research opportunities at those hospitals if that’s important to you.  Heaven forbid you’re engaged or married to another doctor and have to couples match – I don’t even know how those people do that.  

Eventually, you make a “rank list” and submit it to the National Residency Matching Program.  This is your list of the places you have interviewed where you’d be willing to go if offered a position there.  You submit the list in your order of preference.  The programs where you’ve interviewed also submit a list of the candidates they’ve interviewed who they would offer a position in the program’s order of preference.  I’ve been on the other side of this process before too as a chief resident and attending by the way and it’s every bit as interesting and crazy as you’d think it would be making that list.  The computer algorithm then “matches” you to the program that best suits both the candidate and the program.  

One day in March every year is “match day” – the day when every 4^thyear medical student in the country finds out where they’re going for the next 3-7 years.  It’s handed to you on a piece of paper in an envelope. We all open it at the same time across the country.  I’ll leave off the whole scramble process for now because thankfully I didn’t have to do that so I can’t really describe it well (scramble is where those who didn’t match anywhere for various reasons figure out what they’re doing and programs try to fill their empty slots – just as complicated as that sounds!).  

So, the takeaway is this process is crazy but is the fairest way anyone has come up with to give everyone a good shot at programs and finding a job after medical school.  We don’t really choose where we’re going to work for residency so much as choose which programs we’d take a job from if offered.  It’s a crazy day.  If you match in your first-choice program, it’s awesome.  If, like me, you don’t, then there are some tears and some anxiety over what that means for the rest of your life during training – until you realize you have a job in the field you want, some of your friends are scrambling for a spot anywhere in any field, and it could be worse.