The Impossible Reality: What Happens When Medical Students Don't Match

The updates are rolling in this weekend; it's Match Week! This Friday, medical students all over the country are finding out where they'll be living and working for the next 3+ years of their life.

"Smile bigger, Will!!!" - his loving wife

I remember last year well - on Monday, we got the e-mail: Will had matched. The weight we had tried to make light of, the weight that threatened to crush our lives had been lifted. Was the sun extra sunny that day? I think so.

On Friday, our good friend Vy Ahn came over so we could find out our results together. Will and I were nervous but we smiled at each other: we knew Will was matched, we just did not know where or in what field. Last year, Will applied to emergency medicine (his top choice) and family medicine (his next preference). We opened the e-mail and read:

EMERGENCY MEDICINE

BETHLEHEM, PA

Where were we going?!? Who cares! We're in, baby!

A year before this, we had learned a much more harrowing lesson: not everyone matches.

The Association of American Medical Schools reported in April 2014 that

More than 16,000 U.S. medical school seniors matched to a residency position this year, according to data from the National Resident Matching Program® (NRMP®). At 94.4 percent, this year’s Match rate rose from 93.7 percent last year. Despite this improvement, several hundred U.S. medical students did not match to a first-year training program, raising concerns that the 17-year cap on federal funding for graduate medical education (GME) will exacerbate a looming physician shortage.

It was a shock to us - Will had good grades, exceptional USMLE Step exam scores, and excellent letters of recommendation. The problem, we discovered, is that he did not apply to enough programs so as to ensure "enough" interviews (this number is different per field).

The [very simplified] process looks like this:

• a student decides on a field (or two, though this is not necessarily encouraged) and applies to X number of programs. Each program receives 1000+ interview requests, and usually grants around 200 or so. If people do not accept an interview, the program will extend an interview to someone else on their waiting list.
• Interview season begins in October and ends in late January (although I have heard of early February?); in February, students submit their preference for residency spots to ERAS (Electronic Residency Application Service), and in March, they are matched.
• The Matching is done by an algorithm - the students put in their top choices, the programs list their top choices, and the computer makes all the matches. 
• If you do not Match, then you scramble (in another program called SOAP, which helps with the unfilled spots). If you do not get a spot there or do not want to go into a different field, then another idea is to work in a lab or another year of graduate school in a related field. 

We decided not to go into a surgery; we laugh now about how we would have fared living in Brooklyn, NY. Instead, we spent the year in sunny New Orleans. Will got his Masters of Science in Clinical Research at Tulane University, and re-applied to the Match that fall. His school schedule was flexible and allowed him to travel for interviews. Using your "off year" wisely is also a way to show that you are prepared to work hard and continue your education towards practicing medicine.

This is going to be tough. Not matching will be one of the most difficult things to happen. We were newly married, newly pregnant and completely side-swiped. Will going into residency always felt like a given reality. Medical students (soon to be medical doctors) must first go into residency in order to practice in most states. This felt crushing.

It was a really tough emotionally. Will took it the hardest, and I did everything to support him while we worked through it. I still had him go to his M.D. graduation (but not his M.S. graduation). Even if you do not match, there is still a reason to be proud of your accomplishments. You are not a failure. There is so much - still - to do, and try, and accomplish. This is a discouraging set-back, at most.

Outside our family, only a handful of people even knew - writing this now is really stressful for me. We just never brought it up to other people. What could we say? Will is awesome and qualified and still didn't match? But a good friend of mine told me that this story might help other scared medical students (and their loved ones), because there were certainly no stories out there as I obsessively researched options during Match Week two years ago.

So here I am, writing this while Will is sleeping off night shift. It's okay to be scared; it's not okay to be passive.

That was something we faced too late - his passive, unhelpful advisor. If you have one, I really recommend finding another doctor to mentor you. Do not try to go through the March process alone. A mentor can help lead you through this difficult year, and to remind you what a great prospective doctor you are! Will was lucky and when he asked for help, many doctors stepped up and really support him during this time, with advice and recommendation letters.

Again, going through the Match a second time is even more daunting. Of the six people in Will's M.S. program who went through the Match, only three matched a second time. But it's worth it.

Since Will was little, he wanted to be a doctor. He grew up with his grandfather, father and uncles being doctors, and the profession was a natural choice. To watch him grow in residency is extremely rewarding for me: how hard he works, his great attitude, how much he studies, and even when he's frustrated, he does what he thinks is best for the patient. I hear it from other residents, and I see it in his interactions with other residents.

To be his helpmate during that extremely difficult and daunting time for me was hard for me too. It is stressful to not know, especially in pursuit of a desired and hard-sought goal. There was a lot of trust in God and even more prayer. The most important thing to do as a significant other is affirm your person and be with them.

But I can still remember our walk down Tchoupitoulas Street, going to a brewery to meet friends to celebrate (which we got turned away from because Grace Harriet was under 21 years old/ in her stroller). We walked over to Magazine Street to make our way back home, and Will and I just relished the time. We talked with a kind of freedom from those chains of uncertainty. We felt so light; so blessed. As much as it felt like an earned victory, it also felt like a given one too, and one we humbly and graciously accepted.

St. Patrick's Day parade - NOLA 2014

No matter what happens, you will get through this tough period. Repeat this to yourself: you will survive. Maybe you'll adjust your dreams, maybe you'll achieve your dreams - either way, there are still many options available. Allow yourself to think of new possibilities, and embrace the chance for a new adventure!

Moving to New Orleans was the best thing for us - as a couple, for personal growth, and for professional ambitions. It was scary to move so far from home (1k+ miles), to start over and try again. It was the best of times and the worst of times (to quoth Charles Dickens), and no matter what, you will survive - and thrive! - if you let your dreams expand and you work hard, as you already do.

We were lucky enough to have a successful end: Will matched in his desired field. He loves his department, and he finds satisfaction in his work.

This time is stressful, and it is okay to mourn - but this is not the end. Anything is possible!

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