Thursday, March 17, 2011

then and now

So!  Match Day!

Match Day, for those lucky enough to not know, is the day that fourth-year medical students across the country find out where they will be doing their residency training.  Our Match Day was--oh lord, could it have been?--EIGHT years ago.  I was much more awake that morning than most of my classmates, who had been up late partying the night before at "Super Night," our name for the big annual pre-Match bash at the med school.  I'm sure a similar tradition exists at medical schools around the country, and though regional differences surely exist, there is one commonality of which I'm almost certain: the involvement of booze.

I myself was still recovering from a bout of peritonitis when my acute appendicitis in February was misdiagnosed and I subsequently developed a small bowel obstruction and a perforated viscus (TRUE), and so during Super Night I was on Flagyl and couldn't drink anyway.  It was still fun though, and basically ensured that I was not hung over the following morning for Match Day, enabling me to recall each nerve-wracking minute in crystal-clear detail.

I'd heard that in the olden days, Columbia had a tradition of holding Match Day in a giant auditorium, where one by one, students from the fourth-year class were called up to a podium and handed an envelope with their match results, which they were then to open in front of everyone and read aloud, into a microphone.  Of course, not everyone always matches exactly where they want to match, so this ritual (thankfully) came to be regarded as somewhat inhumane, especially in the already high-pressure environment that is med school.

So by the time Joe and I were cycling through in 2003, they had reduced Match Day down to a reception at the faculty club, with a table full of labelled envelopes off to one side of the room.  People could take their envelopes and leave, or open their envelopes there with everyone else.  Within this group, there were people who would open their envelopes and cheer, others who would open their envelopes and start crying, and possibly some that would open their envelopes and promptly punch one of the poor waiters who was trying to pass out shrimp cocktails on toothpicks.  One hopes against that last option, for the waiter's sake.

I am telling you this because the fact of Match Day, and the ritual of Match Day, is one that makes you think that Match Day is probably one of the biggest days in your life.  And it really seems that way at the time.  Hell, Joe and I were getting married about a month afterward, and I think I had put in more time, energy, anxiety and thought into Match Day than I had about the wedding.  It was a big fucking deal, this feeling that the rest of your life was hiding inside this one thin envelope.  It was a big deal, but wasn't.

It was eight years ago.  This is what I can tell you now.  I matched at my first choice program, which was in a Pediatrics residency at the Children's Hospital of New York at Columbia.  Eight years later, I'm not even in that field anymore.  Joe matched in his first choice program too for residency, but for his transitional year, he got his absolute last pick, a fact which deeply dismayed him.  Didn't matter.  He had a great year, got excellent training, and he still has many fond memories of that institution to this day.  We had friends that failed to match at all, and who instead scrambled into spots in other fields, or in cities they never dreamed of living.  They are all successful, happy, healthy, and practicing the kind of medicine they want to practice today.  They have significant others, spouses, children, and they are enjoying their lives in medicine just as much as their lives outside the hospital.  They are happy.  It all works out.

Most of you are probably pretty excited today.  Some of you maybe aren't.  Some of you are dealing with hard choices, and I know that talking about this now doesn't make those choices any easier.  But if you went to med school, I know you have a long memory, so I'll tell you this: some day in the future--five, eight, ten years from now, you're going to look back on this day, this Match Day.  Then you're going to look to the present, at the life you're leading now.  And you might not be where you thought you would be when you were a medical student.  Hell, look at me, I thought I was going to be a pediatrician in academia, and now I'm an anesthesiologist in private practice.  You can't find two more different fields.  I couldn't have predicted it.  But it all works out in the end.  It really does.  You'll find where you need to be, what you need to do, who to go there with, and you'll get there.

So congratulations to all the fourth year med students in the Class of 2011!  Can't wait for you guys to graduate and join the team!

Now on to what's next.


  1. Helixcardinal2:03 PM

    I'm just glad it's over now. Now I can get some sleep!

  2. What an upbeat post! Thanks for sharing your story and for encouraging those just beginning their journey as physicians!

  3. Do me a favor and post this in 2 years when I'm matching :)
    Honestly, great post... thanks for sharing your story, it helps put things into perspective.

  4. Anonymous3:19 PM

    I've actually been starting to think about dropping of medical school because I've been so miserable. Thanks for the reminder that there is a life beyond the rituals and numerous senseless aspects of medical school. It's reassuring to know that people by and large do end up happy and successful, even if their paths aren't those they expected.

  5. I think I need to print this out and archive it for next year, when my husband may or may not match into a program in the city of our dreams.

    Just found your blog today and loving it so far. Can't wait to read the book!

  6. Anonymous3:25 PM

    such a great post. my match day was an absolute freaking disaster and prompted me to consider switching fields, which I did shortly after starting residency. i'm now super happy in the field i picked, living where i want to live, living the life i want to live. it feels like the biggest deal in the world at the time, but you are so right that no matter what happens, you can always figure something out to carve the right path for yourself in medicine. i'm glad i didn't curl up into a ball and die the way i wanted to on match day. i would have missed out on a pretty great life. :)

  7. Anonymous3:44 PM

    You're so right. I matched in Internal Medicine 11 years ago, and now I'm a subspecialty pathologist. Many, many of my classmates changed specialties along the way as well. People who didn't match found new and often much better opportunities. Things work out!

  8. For the current med students above, don't despair. Nine months ago I was told I wouldn't match into the specialty of my choice. I persevered, and today I successfully couples matched, at my top choice for general surgery.

  9. CAL GIRL6:25 PM

    Matched to UCSF anesthesia, can't be happier... I interviewed at Columbia as well, but I love bay area.

  10. Matched into my first choice program in emergency medicine today! It was a crazy crazy day - exactly how you described it above.

  11. This is wonderfully encouraging. I'm only 2nd year, but it's great to hear things like this.

    And about those "Super Night" parties...there's probably booze everywhere but here at Loma Linda. I may find my own party.

  12. Anonymous1:40 PM

    It's easy to say that it will all be okay when it worked out so well for you. It's much harder for a couple who will be separated for 3-5 years or a single parent who must move away from his/her support system or a non-trad who has children old enough to care about where they live. I won't go through this until next year, but my spouse owns a small business, our oldest would be a junior in high school during my intern year, and our two younger children will be 9 and 3. I'm sure that it will work out somehow, but given that you both got your desired specialties in the city where you wanted to live... how easy to say that it all works out.

  13. Anonymous above, thanks for the comment. I know it sounds pat and glossy to say that it all works out, and I am the first to acknowledge that we are incredibly lucky on many fronts, but let me bring up two points of personal history that might lend veracity into a post that could well be interpreted as just blowing sunshine up our collective assholes.

    ONE: Joe and I could not couples match, because the match for Ophthalmology is not run through the NRMP, as Peds was. Therefore the possibility that we, as a married couple, could be matched to programs in two different states, was very real. We dealt with this in an unorthodox way, which is that we decided that both of us would only rank programs in a single city, that city being New York. This was infinitely more risky a move for Joe than for me, because optho as you know is an extremely competitive specialty. But in our triage of life priorities, we were not willing to allow the possibility of living in two separate cities for three or four years. Luckily, as you pointed out, it worked out, but we did have to decide on a very risky strategy that introduced a real possibility that one or both of us might not match at all. However, we prioritized what we felt was more important, which was our marriage over our careers.

    TWO: When Joe was going through the match for oculoplastics, he didn't match through the ASOPRS program at all. He was an excellent candidate, he just didn't match. We ended up getting a spot months later outside the match at a program here in Atlanta, but it was a city where we knew no one and had no family or support system. I adamantly did not want to live in the South. I was not really excited about moving so far away from everyone and everything that we knew, especially with a little kid in tow and a baby on the way. But we did, because the fellowship was very, very important to Joe, and I wanted him to be able to practice the kind of medicine that would make him happy. It was the right decision. And yes, it worked out fine.

    I know it's hard to take "everything works out" advice from someone for whom it seems like things worked out very easily. But we made hard, risky choices, and we've had things go off course. We may still have tough choices to make. But it's not so much what happens to you as how you deal with it.

    Best of luck to you and the decisions you will have to make, and thank you for weighing in.

  14. Anonymous5:48 PM

    Thursday was one of the most stressful days of my life so far. It was unclear to me whether the intense nausea I was feeling Thursday morning was from the cheap wine at our school event or the horrific anxiety that would not let me sleep. I am so incredibly happy now, though, that I have yet to stop smiling. I know, however, that there are those who were less lucky than I in the past few days, and I think your words of wisdom are well timed and greatly appreciated. Thank you!

    Now back to smiling and grinning and dancing around the room!

  15. Anonymous8:18 AM

    I matched a year ago in the Canadian system. I have to say that I understand why people write "it will all work out," however, I think when you don't match or match to anything other than your first choice, these kinds of comments are frustrating. Am I happy in my fourth choice? Not necessarily. I make it work. Would I have been happier in my first choice? Likely. Is there anything I can do about it? Not really, especially in the complicated Canadian system where switching after the match is possible but not easy.

    I think that we, as a profession, need to acknowledge that not everyone is going to have a successful outcome on the match. I think statements to the effect that "most people are happy" ill prepare the next generation of clerks for the real reality that they may not get their top choices or even match at all. I think you are correct in your statement "that it will all work out," but only after grieving for what could have been, adjusting to a new life plan and relying on friends and family for support.

  16. I'm not even in med school yet, but I'm already scared of Match Day. So much hanging on one day.

  17. Anonymous7:45 PM

    At least now 4th years-about-to-be-interns get the news on their computers at home where they have a chance to decide how to react when they face their family and friends with either fabulous, or less than fabulous, news. Doesn't make it less monumental but at least a little more private. All the emotions you described so well are accurate! :-)

  18. Anonymous12:55 AM

    I couples' matched in the Canadian system to our 4th choice. I wasn't sure if I was happy on match day. There were a lot of uncertainties. My entire residency ended up being amazing. Partly because the program; in the end; was fantastic. But part of the reason was that we worked hard to be optimistic and excited about the decision that we had made.
    The whole match process stinks; its a very hard system. But regardless of the outcome, there is something to be said for making your own happiness.

  19. Anonymous2:40 PM

    I think this is a great post because it reminds us that there are many uncertainties beyond the seeming finality of Match Day. Medical schools trump up the Match result as the culmination of everything you have worked for during 4 years. It does not help that the system does not really take other factors in applicants' personal lives into account -- ie, family considerations, employment of spouse or SO if not in residency too. So it is a set-up for huge disappointment and stress for those who do not get their top choices.

    However, it is important to keep in mind that the results are not set in stone. People do make changes--specialty switches, position swaps, and program changes. Many PDs are reasonable people and will help residents makes needed changes, including program changes within the same specialty for family reasons. This is coming from someone whose "top choice" match on Match Day several years ago turned out to be a terrible fit specialty and location. I tried to make the best of it, worked with my PD, and now I am very happy in a new specialty and better location. So, remember, changes can definitely be made, even if it seems like your match is final.