The Match: Revisited

I have now been through the match twice. It has worked out well for me both times, so I cannot complain too much. But I must say that I still feel that it is a bizarre and rather draining ritual. I am not really sure if there would be a better way to apply for residencies. A colleague told me that a similar match system was used at her undergraduate university for people rushing sororities and fraternities. She said it worked out well for most people and that even if they felt disappointed on rush night, they usually realized in retrospect that they ended up in the best fit sorority for them. From what I have heard from medical school classmates, most people now seem pretty happy with their matches 2 years later. So I guess it does produce good results for many people, even if the process can be rather painful.

Here are a few thoughts on the match after the second time around. Hopefully, they will be helpful to someone out there.

1. Don't panic if the interview invites come late. Both times I received interview invitations from great programs after the dean's letter came out. Some programs send invitations later than others. Also, do not panic if other people have gotten invitations and you have not. It takes some time for programs to get through reviewing all of the applications.

2. The interview matters. Speaking from both sides of this process, as a resident and an applicant, I can say that the interview matters in this process. It really shapes both the program's and the applicant's viewpoints of each other. Having the best package on paper does not matter much if the residents from the interview lunch remember you as being combative, arrogant, or a total douchebag (all terms I have heard used to describe resident impressions of applicants who did not behave well at their interview lunch). And from an applicant's perspective having an uncomfortable interview or a bad experience with some aspect of the interview day can really color one's opinion of a program for the worse.

3. Do not believe everything the program tells you. Luckily, I felt like most of the programs that I visited both times on the interview trail were decent programs with program directors who sincerely cared about resident learning and development. That said, remember that the program is selling itself to you. No program will ever be perfect and without flaws. Residency training is an experience that is going to be painful at times, no matter how good a fit a program is for you. Knowing this, especially the second time through the process, made it easier for me to evaluate the programs more critically. Try to have realistic expectations of what they can offer you, so that you are not disappointed in the end.

4. Make sure the program matches your goals. This sounds obvious, but too often we are encouraged, especially in academic medicine, to solely focus on factors like prestige, fellowship placement, and research prowess when selecting a residency program. Think about your career goals and how the program will get you there. If you want to do a competitive fellowship then some of the above mentioned factors may be really important. If you want to work at a community hospital in primary care then things like job placement in the community and outpatient experiences during residency may be more important.

5. Look beyond intern year. On a related note, probe deeper into what the program will offer you in the long run. Ask residents if the program is supportive when they are applying to fellowships and looking for jobs. A lot of interview days focus on things like the intern year call schedule and how to transition to the city the program is located in. It is similar to the focus that many medical school applicants have on the preclinical curriculum when interviewing for medical school. The later years likely will be more influential on the direction of your career.

6. Talk to residents. Try to meet as many residents as you can and talk to all of them. See if you could really see yourself working with them. Determine if they seem happy, overworked, stressed, relaxed, etc. You may need to talk to residents outside of the program-sponsored lunch or meet-and-greet at the interview day to get the full story. Social events the night before can be a good place to get a decent sense of this.

7. Do second looks for yourself. There is a lot of debate about whether one should revisit top choice programs before making the rank list. I have been on both sides of this one now, as an applicant and as a resident lunching with re-visit candidates, and I really have no idea if it really helps an applicant move up on the rank list. There are some programs that emphasize re-visits at the interview day, so maybe at certain places it is more important to go and show interest. I am not really sure. Anyway, do re-visits if you feel they will help you make your list. I did two at programs I was having a hard time deciding between and it dd help me get a better sense of both programs. I got to meet more residents and to see the true work environment in real time. In the end, I thought they were helpful and luckily I did not have to travel too far to do them.

8. Assess the administration of the program. I have been lucky to be in a program with great administrative support for the past two years. Our program coordinators are awesome and I remember feeling that my interview day flowed really well. If the interview day seems disorganized, ask the residents how they feel about the program support. Things like getting a medical license and setting up computer access at various sites can be time-consuming, so having good administrative support behind you can be a lifesaver.

9. Trust your gut. Listen to that inner voice that tells you one place would be a great fit and that another would make you unhappy. First impressions are really important. I really think that we can pick up on subconscious cues while visiting places that influence our decisions. The vibe you get at the program is important.

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.