T-2 Weeks and Counting

It's almost time for all of the folks planning to match in this year's Match to submit their final rank lists. I can hardly believe that just one year ago I was in the same boat. Trying to figure out which residency program will be the best fit for you can, if you are lucky, be quite simple. Or, for many people, making the final decision can be rather difficult.

We had someone come back for a second look at my program today and I was one of the lucky few who got a free lunch at a posh restaurant to answer the applicant's questions. Being on this side of the matching process I can honestly say that I have no investment in what people decide to do. Of course, I would like to have friendly, hard-working people come to our program. But I also know that decisions are highly personal and take into account many factors, which often are about more than just the program itself. For example, last year I visited a program that I knew throughout the interview day would be perfect for me and my career goals. I clicked with the faculty and the residents, loved the hospital and the patient population, and thought the program structure and schedule were among the best I saw. But it was in a city that I knew we would be miserable living in, so it went lower on the rank list than it would have gone bases solely on the program.

Making my final rank list was difficult and caused a lot of stress, especially in the last couple of weeks. Based on my experiences last year interviewing/matching, my residency so far, and the experiences of some who have come before me, here are a few thoughts on trying to figure out how to make the rank list.

1. Relationships. Yes, this is about your career and getting good training so that you can become the best doctor possible. But it is very important to be happy and supported outside of work too. And maintaining relationships, of any type, in residency definitely takes work given the constraints on your time. If you have a spouse/ significant other, take his/her feelings into account about where he/she would like to end up. If you are single and hoping to meet someone in the next several years, you may want to consider how hard/easy it will be in the location of your program. Having friends/family to hang out with, especially, those who are not in medicine, can also provide a nice escape from work.

2. Location matters. You do not want to be in a place that you think you will be miserable living in. Yes, you will not have a lot of free time in residency, but you want to be able to enjoy the time you do have outside of work. Also, think about quality of life issues. How long will your commute be? How pricey is housing? If you have kids or are planning to do so, how is daycare availability?

3. Be realistic. Every program puts their best foot forward on interview days and at second looks. Even rotating at a program may not give you the whole picture. Realize that every programs has its high points and its flaws. If you talk to enough people you will likely find someone who will complain about something. Try to feel out obvious red flags, ie programs on probation, multiple residents who openly express unhappiness about teaching/mistreatment, programs that do not let you talk to residents at all. Often you don't see any obvious things and this can be good--it can mean that you are considering programs that will all train you well.

4. Match your career goals. This may seem obvious and is more applicable in some fields than others. But I think this discussion sometimes gets lost. Many of us are influenced by our advisers, who are academic physicians, to pursue academic medicine or have only been exposed to academic practices. Also, I've seen that programs often sell themselves by touting fellowship placements since fellowship is the next step in many fields. If you want an academic career, are set on doing a fellowship, or want to do research you should consider these things. However, if you honestly see yourself in private practice as a generalist, this might not matter as much. It is okay to match at a "less prestigious" program if it is the best fit for your goals. When evaluating a program think about where you really see yourself in 5 years, 10 years, 20 years down the road. Then see if the program's placement of graduates will help you get there.

5. Think ahead. It's easy to focus on intern year since it looms ahead, just as it is easy to focus on things like the basic science curriculum when trying to pick a medical school. If you can get some input from upper level residents it can be helpful when evaluating programs. See if they feel supported throughout the program, if they get good career advising, and what they feel their strengths and weaknesses are at the end of the program.

The bottom line is that you will probably have several programs at which you feel you will be reasonably happy at and get good training. In the end, it works out for most people, even if it does not feel that way right now. So take a deep breath and make that final list.