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...and sometimes the light at the end of the tunnel is an incoming train.
The match is more than half a year away and it is already giving me the heebie-jeebies. Buried somewhere under all the pina coladas that 4th year medical students are supposed to be drinking is the little fact that we will be honest-to-god doctors next July. The NRMP Match is the algorithm/system that will determine exactly where we will wreak havoc on unsuspecting patients. (That's a slight exaggeration, but if I were you, I would try not to go to a hospital in July. This is when overwhelmed interns are coping with no longer being able to say, "I have no idea, I'm just the medical student.")
At its core, the application process is very similar to that of high school students applying for college, or college students applying to graduate school. You fill out an application, write a personal statement, get some letters of recommendation, and pay some fees. Then you twiddle your thumbs while the interview offers trickle/flood in. You typically go on these interviews from November through January.
After interview season ends, all applicants and residency programs participating in the match will finalize their rank lists. An applicant's rank list is comprised of programs that he/she interviewed at. Number 1 on your rank list would be the program that you want to go to the most. You can rank as many programs that you want on your rank list. If you interviewed at a place (or places) that you would never ever consider going to, i.e. you would rather take a year off or do the Scramble, then you can leave it off your list.
A program's rank list, of course, has applicants listed in order of desirability, which is roughly a function of your academic record, board scores, letters, interview, etc. If a program is trying to match n applicants (i.e. it has spots for exactly that many new residents), it will have to put many times n on its actual list. This is again only the applicants that were interviewed. If the program would rather not fill than have you in their program (ouch), the they will leave you off their rank list.
Here is what then happens: The algorithm will scan your list of programs. It will try to match you with your #1 choice. If you are anywhere on the rank list of your #1 choice, you will be matched there temporarily. Then it will run through the rest of the applicants who have also ranked that program. If another applicant ranked the program high enough, and is higher than you on the program's rank list, then he will get a spot above you in the temporary match. If he is ranked below you, then you will keep your spot temporarily. To get matched at a program with twelve spots, the applicant will have to end up being in the top 12 applicants after the algorithm has been run for everybody.
This favors the applicant over the program, because it will always try to match you at your #1 choice if possible. If you get bumped off the totem pole for your #1 choice, it will do the same thing with your 2nd choice and the rest of your rank list if necessary.
The results of the match are celebrated in grand and dramatic fashion. Everyone in your class will be gathered in a nice room for special occasions. There will probably be champagne. At some exact time, everyone will get an envelope with the name of the place where they have matched, and proceed to open it at the same time while the various advisers and doctors that you have gotten to know in the past 4 years are looking on.
Exciting? Yes. Potentially horrifying? You betcha. Thankfully, if you did not match at all, you will find out before match day and be spared the humiliation of opening an envelope with nothing in it. However, that still leaves the possibility of matching at your last choice, or second-to-last choice, or any place at all that you were not prepared to be going to. Most people will be thrilled (and certainly the females will throw out high-pitched squeals of delight) or at least show some enthusiasm. On the flip side, there will be people in tears, and I can't blame them. The culmination of all those late nights in the library, the stressful tests, the early mornings, the massaging of difficult personalities...it can all be summed up by what is written on that piece of paper. To have the decision process drawn out through 6 months and climax in a room filled with all your peers - I would say that is not ideal if the news is not good.
But wait, you say. You don't have to tell anyone where you got in. No one ever has to know. It's true that you don't have to tell a soul, not even your closest friends. However, there is a very public thing called the "match list" that shows where everyone in your class is going. This list is important for prospective applicants and underclassmen to see the types of programs people are matching in. It also allows you more easily keep track of your soon-to-be ex-classmates. On balance, a public match list is a good thing. However, you agree to be put on this list before you ever find out where you match. Most people, optimists that they are, will consent to being on the list.
Why does the match day bring such extremes of emotion in comparison to college or graduate school acceptances? Besides the stuff I already mentioned, there is the fact that even the youngest of graduating medical students will be on the wrong side of 25. It is about that time to start considering how you want your life to pan out. And the great percentage of people end up working somewhere near the area where they do their residency. That is where you work with the big wigs of the area and meet your future colleagues. Obviously, this is not true in all cases, but for the graduating student, it seems iron-clad.
Disappointments will tend to fade, as they always do. After sufficient time, almost everyone will make peace with where they ended up. After all, they ranked the place for a reason (hopefully). That said, it's a minor miracle that Match Day has continued to be a tradition and that almost everyone attends it.
 
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CA10828 Posts
good luck! that sounds really intense haha
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Nice read, I have friends in medical school, hence I have read a little about residency for curiosity sake. Plus the NRMP is interesting from an economics/game theory standpoint (on which Alvin E. Roth wrote about and even updated)
http://en.wikipedia.org/wiki/Alvin_E._Roth
Hey OP, mind telling us which programs you hope to get into? 
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Good luck getting into your top choice OP! What's the situation for above average but not top students who want to get into difficult residency spots (derm, rads, onc, ENT)? Do they usually take the risk with their top few choices to be matched into one of these programs? And does anyone ever really not get matched anywhere? I can't imagine a graduating medical student not being able to get an IM or FP residency.
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It's great to see some fellow TLers who are also in medical school! I'm currently a 3rd year medical student who is finishing up my trauma surgery rotation, which has actually been pretty relaxed in terms of total work hours per week! I'm curious what field you are hoping to match into? I've always wondered if gamers tend to favor one particular specialty...
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oh man this is crazy! I thought I was stressed having Med School interviews coming up next month, this is like ten times more intense ~~
may I ask where you go?
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United States4053 Posts
On August 16 2010 09:22 Entropic wrote:Nice read, I have friends in medical school, hence I have read a little about residency for curiosity sake. Plus the NRMP is interesting from an economics/game theory standpoint (on which Alvin E. Roth wrote about and even updated) http://en.wikipedia.org/wiki/Alvin_E._RothHey OP, mind telling us which programs you hope to get into?
Odd, the first non-medical thing that I thought of when I read the OP was this mathematical topic
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On August 16 2010 09:22 Entropic wrote:Nice read, I have friends in medical school, hence I have read a little about residency for curiosity sake. Plus the NRMP is interesting from an economics/game theory standpoint (on which Alvin E. Roth wrote about and even updated) http://en.wikipedia.org/wiki/Alvin_E._RothHey OP, mind telling us which programs you hope to get into?
I haven't finalized the list of programs I'm applying to yet, but I know for sure I'll be applying to all 13 anesthesiology programs on the West Coast for starters. Probably will end up applying to about 30 total.
On August 16 2010 12:22 Try wrote:
Good luck getting into your top choice OP! What's the situation for above average but not top students who want to get into difficult residency spots (derm, rads, onc, ENT)? Do they usually take the risk with their top few choices to be matched into one of these programs? And does anyone ever really not get matched anywhere? I can't imagine a graduating medical student not being able to get an IM or FP residency.
For the most competitive residencies (derm, plastics, maybe a few others) there are very very few applicants who are not at the top, because even those at the very top may have trouble getting in. For stuff like rads and ENT, most "above average" students will apply to a huge number of programs, like over 50. I have heard of people applying to >100 (literally every program in the US). I think most of these people tend to have a backup plan. You're right that very near 100% of graduating students should be able to get a FP spot, even if they have to scramble. IM is a little more competitive, but should also be no problem for above average students.
On August 16 2010 12:37 Roflsaurus wrote:
It's great to see some fellow TLers who are also in medical school! I'm currently a 3rd year medical student who is finishing up my trauma surgery rotation, which has actually been pretty relaxed in terms of total work hours per week! I'm curious what field you are hoping to match into? I've always wondered if gamers tend to favor one particular specialty...
Anesthesiology. See previous blog post. I don't know if there is one specialty that gamers prefer, as I know some that are going into many different fields - IM, rads, EM, gen surg, etc.
On August 16 2010 15:20 bh. wrote:
oh man this is crazy! I thought I was stressed having Med School interviews coming up next month, this is like ten times more intense ~~
may I ask where you go?
I go to a state school in the Northeast. PM me if you want more details.
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16981 Posts
Fun fact: the same computer program used to match med students to residencies is ALSO the same computer program that matches girls to sororities! Everyone wins!
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On August 16 2010 15:38 infinitestory wrote:Show nested quote +On August 16 2010 09:22 Entropic wrote:Nice read, I have friends in medical school, hence I have read a little about residency for curiosity sake. Plus the NRMP is interesting from an economics/game theory standpoint (on which Alvin E. Roth wrote about and even updated) http://en.wikipedia.org/wiki/Alvin_E._RothHey OP, mind telling us which programs you hope to get into? Odd, the first non-medical thing that I thought of when I read the OP was this mathematical topic
This is exactly correct. The NRMP is based on the Traditional Marriage Algorithm used to match suitors and reviewers. The proof of that algorithm was such a pain in the ass.
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On August 16 2010 22:29 Empyrean wrote:
Fun fact: the same computer program used to match med students to residencies is ALSO the same computer program that matches girls to sororities! Everyone wins!
seriously? that is pretty awesome.
Edit: And for all the guys talking about the math behind it, that is actually quite interesting. It is really a pretty elegant solution and much much better than what it was in the past, i.e. potentially having to accept a less desirable spot because they replied first and you don't want to risk not having any position.
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On August 16 2010 19:25 radar14 wrote:
Anesthesiology. See previous blog post. I don't know if there is one specialty that gamers prefer, as I know some that are going into many different fields - IM, rads, EM, gen surg, etc.
I actually ended up browsing through your entire blog and reading all of it, haha. Your thought process and reasoning behind choosing anesthesiology makes a lot of sense. In particular, the distinction you draw between the anatomic/pathologic specialties vs. the physiologic/pharmacologic specialties is both interesting and true. Like yourself, I definitely fall into the latter category. I also feel that "procedural/technical" vs "cerebral/conversational" is another key difference between specialties. I am much more of a thinker than a doer, so that makes anesthesiology less attractive for me. I must say, though, that the specialty definitely seems like a solid choice, due to the high salaries, relatively chill and "controllable" work hours, and the ability to SIT DOWN in the OR!
I was wondering what your thoughts and experiences were regarding pediatrics? I originally went to medical school because I wanted to be a pediatrician, and I have found myself really enjoying my clinical interactions with kids. In fact, even though I am on trauma surgery right now, I always choose the pediatric trauma patients to pre-round on, and checking in on them in the morning is one of the highlights of my work day!
When I compare these kids with old and obese patients suffering from a variety of lifestyle-induced chronic illnesses, it really boggles my mind as to why someone would choose adult medicine over pediatrics. While I firmly believe that any sick individual deserves quality medical care regardless of the story behind their illness, it just seems to me that there is a certain sense of futility which inevitably develops after treating this patient population on a daily basis. I suppose that one could derive some degree of intellectual satisfaction from the challenge involved in juggling the multiple medical problems and comorbidities which are legion in the average adult patient on the wards, but is that really enough?
Anyways, I'm starting my pediatrics rotation in two weeks, and while I am very excited about it, I'm also quite worried that there is a "dark side" to pediatrics which I have not yet been exposed to. I understand that the relatively "low" salaries of primary care pediatricians is a red flag for many medical students, but I am fortunate enough to not have to worry too much about loan repayment. Besides the money, what are some other key negatives that you see in pediatrics? I'm the type of person who likes to go into things expecting the worst and then being pleasantly surprised when they turn out to be better, so feel free to tell it to me straight!
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Or you could go to grad school spend approx 6 years to get a Ph.D. at which time you will have to do a Postdoctoral 'residency' which more often than not lasts upwards of another 6-8 years. At this point you still have a significant chance of not landing any kind of job.
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On August 17 2010 04:49 Roflsaurus wrote:
Besides the money, what are some other key negatives that you see in pediatrics?
The parents. 
Nothing more annoying than the nervous parent of a patient. Nothing. Can't blame them, though. And most settle down if you just talk to them for 5 minutes.
I really enjoyed pediatrics. I don't know that there is a "dark side."
Not like adult medicine, where you spend so much futile time doing things like lecturing crack addicts about why they should stop smoking crack and they stare at you like you just killed their dog.
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Actually anesthesiology salaries are probably going to be decreasing in the near future; it's at least a distinct possibility. Fair warning to anybody considering it.
Re: pediatrics
Really, you will learn more than I could ever say by just doing the rotation especially since you're interested in it. Since you asked though, here's one person's opinion...
Pros: Definitely a "thinking" specialty. Pediatricians are up there with internists in terms of raw medical knowledge. Working with kids can be really cool, and you'll often find yourself with a stupid grin on your face. Also, diapers not withstanding, kids smell waaaaay better than their adult counterparts, and are much more hygienic. Kids also tend to get better. At a young age, the human body can recover far better. This translates into a real sense of accomplishment for you. A whole slew of subspecialties to mirror those of internal medicine (e.g. peds nephrology, peds cardiology, etc).
Cons: Parents can be a drag, as can social issues in general. Dealing with child abuse is really emotionally draining. As with medicine, there is a LOT of paperwork that is mostly busywork and not intellectually stimulating at all. Kids, while cool sometimes, can also be a real pain sometimes. I'd rather do a prostate exam than try to examine another 2 year old's ears. Peds clinic is omgwtfbbq boring imo. Well child checks, growth charts, immunizations = zzzzz
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That's some great advice and information, thanks a lot! Radar14, some of what you say actually reminds me a lot of this one blogger called Panda Bear MD that I started reading back when I was a pre-med. Not sure if you've heard of the guy, but his material is great. A somewhat cynical yet honest look at the clinical years of medical education. In recent years, his blog has sadly transformed into a rabid political critique of the Obama administration, but his archived content is terrific. Anyways, here's the link if anyone wants to check it out. Thanks again for the info, and I hope you continue blogging about your 4th year experiences and beyond!
On August 17 2010 06:38 sutureself wrote:
Not like adult medicine, where you spend so much futile time doing things like lecturing crack addicts about why they should stop smoking crack and they stare at you like you just killed their dog.
I lol'ed. Sad, funny, and true. You wouldn't by chance happen to watch "The Wire" would you? Awesome TV show about the drug trade and corruption in Baltimore, and your description of IM reminds me of this one scene from the show...
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