January 26, 2009

• The Match: Or, Where I have been the last 6 months

  (Because everyone is asking “are you a doctor yet” or “so, did you get a job?”)

  For many of my real life friends, I have dropped off the face of the planet since roughly June of 2008. For those of you stuck here in this series of tubes, I have been gone for minutes, perhaps even days at a time. At last it is time for me to fill you in on what I have been doing with myself instead of posting.

  By your final year of medical school you have to decide in which specialty you want to train. It could be anything from Internal medicine to Pediatrics to Obstetrics to Surgery…you get the idea. (Except for things like Cardiology or GI, where you actually go into your field first and then subspecialize by doing another 3-5 years of training called “fellowship”…but I digress.

  Picking a specialty is a lot like picking a college major…except it actually DOES make a difference because this is something you will be doing for a minimum of 10-15 years while you pay off your loans. Once you have picked a specialty, you then have to figure out where you want to do all your training. See, when I graduate medical school in June, I will technically be a doctor, but I wont actually know anymore than I do right this moment. So I go through a 3 year period called RESIDENCY where I get exposure to ideally everything so I can learn how to make medical decisions second nature. During this time, I am making decisions, but there is a safety net of older residents and attendings who have ultimate responsibility and can change my treatment plan or diagnosis accordingly.

  Where you go for residency depends on a lot of factors, like reputation, location, amenities, program size, research opportunities and others. The saying goes you can pick your region (of the nation) or your specialty, but not both. I have learned this to be true to my dismay, as I initially applied for ophthalmology fairly selective to region and did not match because I did not cast a wide enough net.

  The application, which I have talked about earlier is submitted through a computer program called ERAS which stands for Evil Rulers of Application Selection. It takes your grades, your evaluations, your test scores, that one time you stole susie minkins lunch money for saying you had cooties, your personal statement, everything you have done in your life to prepare yourself to get into and through medical school. ERAS then collects all this information in one place and you pay arbitrary amounts of money depending on how many programs you want this info packet sent to. Someone like me who dual applied for specialties will end up spending around $900 dollars.

  Usually by October/November you have begun to hear back from programs you applied to with a couple dates they are available to interview. You then have to schedule everything like a gigantic jigsaw puzzle with no edges and all one color pieces. You’re constantly balancing booking programs with trying to group them regionally, so you’re not flying back and forth across the country all the time. Because yes, you are paying for this yourself.

  So you fly to these different programs and interview, which I have been occasionally updating to tell you about. You usually get some bagels or fruit in the morning, then a powerpoint slide show about the residency program, why its unique and a chance to ask questions. In fact, “what questions do you have” is the most common question you will hear and it is usually in your best interests to have one every time. You will interview with 2-3 faculty or residents , and then get lunch, a tour of the hospital, and sometimes a social event to meet the residents outside of a hospital setting.

  And did i mention you are paying for all of this yourself? Airfare, meals, hotels-all out of your rapidly dwindling loan money (because I dont get any more loan checks after this year, I will actually be earning money, however little). I was extremely fortunate and had friends in every city I interviewed (special thanks to JESS, WARD, WENYIN, WENDY, KENNY, ARI, and TED-for the places to stay, the meals, and just the company in general-I owe you guys) but the process has still been pretty expensive.

  So by this point, I have done all that, taken and completed my Step 1 and Step 2CK and step2 CS (my licensing exams, so the only thing standing between me and an M.D. at this point is time and a place to actually practice.

  Now to the Match part of it. By getting an interview to a place at all, you kind of have a potential job offer. It works like this: the med student (that’s me) ranks all the places he interviewed. The residency programs (that’s all 16 or so hospitals who interviewed me) ranks all the candidates they interviewed. Then a big computer program (in my head a scantron machine the size of the sears tower) MATCHES everyone up.

  The match favors the resident so:
  if two programs rank you #1 but you rank program A higher than program B, you go to program A
  if program A ranked you #30, but program B ranked you #2 and you ranked program B higher than A, you go to B

  So in the end you are supposedly put where you most want to be. And most people tend to end up at one of their top 4 choices, though of course there are those who end up at their 10th or 12th choice or worse yet, dont match at all and have to do something called “The Scramble”. I chose not to scramble for the one ophthalmology position in the entire country because I took a long hard look at myself and decided I would be happier doing internal med at a hospital of my choice than toughing out 4 years in Indianapolis to train in opthalmology. Lets hope I dont have to do a post explaining how the scramble works for the regular match.

  Everyone finds out where they match this year on March 19, 2009. The results get revealed at noon east coast time, 9am west coast, and so on and so forth. And then, July 1, you start your internship. You are contractually obligated to go wherever you match, so from now until febuary 17th, every medical student (who ISNT in optho anyway) is poring over our RANK LISTS to decide where we most want to be

  But once that is done, I am basically just amping up my thumb twiddlin’ muscles.

  Hope that answered all the questions I dont think you guys have. The next few posts I will try to work on in the midst of making my rank list will be my favorite and least favorite things about med school.

  And if there is anything else you want to know, just leave a comment or send me a message, because this is the last ask a medical student post I will be running. Next time I run an open Q and A, almost Dr J will be completely Dr J

  -Almost Dr J

  • 12:25 am
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