The Residency Match

Becoming a physician is a long and difficult process. Although most people are aware of the competitive nature of getting into medical school and the long hours of study, class work, and laboratories that must be successfully navigated in order to graduate, they are not aware of the necessity of getting into and finishing a residency in order to get a medical license.

Graduating from medical school allows one to be called “Doctor” with all of the privileges associated with that degree, but there is more to do if one is to be licensed to practice medicine. The states require at least one more year after medical school whereby the graduate acts as a resident in a formal resident training program. Even those who want to be a general practitioner (GP) must go through a year of training and then must pass the third part of the United States Medical Licensing Exam (USMLE) in order to get a license. Most residencies require more than one year; for surgeons, most have to go through a five year program before they become “Board eligible” in their surgical specialty. In my case, I did five years in general surgey and later, two more years for cardiothoracic. So I was “boarded” in two specialties.

Senior medical students go through a matching process in order to get into a residency. First they must choose the type of residency they want, e.g., surgery, medicine, psychiatry, Ob-Gyn, pediatrics. They must then apply to a place that has a training program in their chosen field. Eventually, a computer will match the applicant to a program.

Based on the advice of Val Willman, then the Chairman of Surgery at Saint Louis University (my medical school), I did senior rotations at the University of Chicago and Northwestern University. I was hoping to increase my chances of getting accepted to those programs by letting them see what I could do in a hospital setting. I wanted to get back to Chicago, my home town, and these were good programs for surgery training. I also applied to Baylor in Houston, Rush, Loyola University, the University of Illinois, the Medical College of Wisconsin, and, of course, Saint Louis University.

I ranked the University of Chicago number one but felt my chances of getting into such a high-powered, prestigious place were very slim. Most of the residents I had met during my rotation there were from from very well-known medical schools such as Harvard, Hopkins, Yale, and the University of Chicago. I wasn’t sure they would give a slot to someone from Saint Louis University, but, I was advised to aim high and that’s exactly what I did.

I had a great set of interviews at Baylor and I felt that was where I would match. They seemed to be impressed with my undergraduate degree in Biomedical Engineering and they knew Dr. Willman who had written me a strong letter of recommendation. The Baylor program was run by Michael Debakey, a world renown surgeon. It was known as a demanding program. Residents rotating on the cardiac surgery service spent 2-3 months in the hospital and were not allowed to leave. In fact, there was a story told of a resident who went down to the parking lot to see his wife. He was fired the next day for exiting the hospital. I felt I could do well in that environment since I was not married. I ranked Baylor #2.

The day that the senior medical student learns where he will be doing his residency training is called “Match Day.” Usually there a few days before the match where students that have not matched are informed as is their medical school. The national residency slots that are still open become available for these unmatched students and a scramble ensues whereby the programs that have open slots are able to contact available students that they are interested in. If the student accepts the offer, that slot disappears. Slots that are still available undergo the same process in a precisely timed order and, again, available students are given offers. The process continues until all slots are filled and, hopefully, all medical students have a job lined up for the next year, at least.

The original matching is done with a national computer match. The students make a ranked list of their residency choices and the various programs make a rank list of the students they would like for their programs. The computer, through some mathematical magic, will link the students with a program in such a way as to get the best match for the student and the programs.

We all knew what day the unmatched students would be notified so those of us who did not hear anything at least knew we were going to some program that was on our rank list. On the day of the match, the senior class all met in one large room and envelopes were handed out in alphabetical order. Since my last name began with a “W”, I had to wait till near the end to get my envelope. I opened the envelope and found that I had matched to my first choice—the University of Chicago. I was going back home to Chicago, hopefully for five or six years—the time required to complete the surgery program.

“…immune to ‘paper’ achievements; it was the process that held my interest.

…I was taught to think and act as a surgeon, to be open, empathetic, to handle very stressful situations no matter how exhausted I may have been. I am the result of what my mentors trained me to be.”

In becoming a physician, there are many memorable dates that stand out. Getting the first letter of acceptance to medical school, the day of medical school graduation where we all took the Hippocratic oath, match day when we learned where we would do our residency, the day we learned that we had passed our Boards. In order to become an independent practicing surgeon, all of these tickets had to be punched. All of the hard work, sacrifices, and hopes would not matter unless these requirements were successfully met.

In my case, passing the Bar Exam many years later was also important but by then I had become pretty much immune to “paper” achievements; it was the process that held my interest.

For me, my match day was 39 years ago. Having been subsequently successful on those other noted critical days, I never had to consider alternatives and for that I am thankful. I often have time for reflection where I remember those who directed me to medical school, those who helped me get into the residency program where several mentors helped to mold me both professionally and personally. I was taught to think and act as a surgeon, to be open, empathetic, to handle very stressful situations no matter how exhausted I may have been. I am the result of what my mentors trained me to be.

I hope that the young medical school graduates who have recently gone through the match have the same types of career and life satisfactions I have been fortunate to experience. Young doctors, go forth and make us proud.

by Darryl S. Weiman, M.D., J.D.

Professor, Cardiothoracic Surgery, University of Tennessee Health Science Center and Chief of Surgery, VAMC Memphis, TN

MORE ABOUT THE AUTHOR: Darryl Weiman is a featured expert in on February 17, 2016. 

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