(‘Cause everyone’s been asking, “So did you get a job?”)

I find it best to begin at the beginning.

In your final year of medical school, you have to decide in which specialty you want to train . This could be anything from “Internal Medicine,” where you would become an internist, to “Pediatrics,” where you’d become a pediatrician, to “Urology,” where you’d become a urologist. Radiology, Neurosurgery, Emergency Medicine–it’s all there. (Except some Internal Medicine specialties, like cardiology, endocrinology, which require you to do an internal medicine residency and then another training session called “Fellowship.”) Anyway. You decide your specialty, and then try to figure out where you want to train for residency*.

So while you’re figuring out where you would like to train for residency (based on a number of factors like reputation, location, research opportunities, etc.) you’re preparing an application for these residency programs. It’s a big electronic folder of things like grades (if your school has them), board scores (standardized national exams everyone has to take), letters of recommendation, evaluations from your time working in the hospital, extracurricular activities, research, and a one-page personal statement. So you submit that to a big centralized clearinghouse called ERAS , which charges you a fee based on how many places you apply to
. Depending on how competitive your specialty is (orthopedics, radiology, anesthesia are often at the top), you may end up applying to an insane number of programs. Like 40. This can be $500-$600 just to apply.

You want to get your application in ASAP, because residency programs can start downloading parts of it as soon as you pay, and can start offering you interviews whenever they want. Technically, they don’t have your full application until November 1, when your medical school releases your “Dean’s Letter,” a summary of your performance during medical school and sometimes has a ranking, grade, or keyword (“Graham is a good candidate,” vs “Graham is an outstanding candidate”) to differentiate students at the same medical school. But anywhere between late October and early November you’ve heard from most programs via email as to if or when they’re going to offer you an interview. For some of the more competitive programs, you may only get offered one or two dates (“Please come interview November 28 or 29”). It’s then a scramble to quickly email/call the programs back and confirm the date you want. 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 go around to different programs and interview. You’ll usually interview with 3 or 4 faculty or residents (at least in my experience), both for you to get a feel of the program and its faculty, as well as for the program to get to know you. You get a tour, breakfast and lunch, and often there’s a social event the night before to get to meet the residents outside of the hospital environment. They tell you the specifics about the residency program, why the program is unique or special, you get a chance to ask questions. (In fact, often the most common question you’ll hear is, “So, what questions do you have?”) And as I said before, you’re paying for all of this yourself. Airfare, hotel, meals on the road–it’s all on you**. I lucked out and had friends in every city where I interviewed (Thank you Eric, David, Sam, Deepika, Jesse, Eric, Eugene, Ed, Kenji, Dave, Allison, and Mike, I owe you all BIG TIME!) but still the process will end up being expensive for me to fly all over. People trying to match as couples often spend around $5,000 interviewing, depending. This is of course just loan money, so by the time we’ve paid it off it’s tripled in cost. But I don’t have ideas for a better system–you gain a ton by going to the institution and seeing it yourself.

Now to the Match part of it. I explain it this way. By getting an interview, you kind of have a potential job offer. How it works is this: the med student ranks all the places he or she interviews. The residency program ranks all the candidates they interview. Then a big crazy computer program ( The NRMP, lovingly known as “The Match” ) … matches everyone up. There’s a good explanation of how it works here. 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.

Everyone finds out where they match this year on March 20, 2008.*** Technically we’re all supposed to find out at the same time–that is, students on the East Coast would find out at noon their time, and on the West Coast we’d find out at 9am, but often your friends on the East Coast are already calling and texting and emailing their results early, ahem. And then, July 1, or around there, you start your internship.* You are contractually obligated to go where you’re placed, so right now the thousands of medical students about to graduate and I are all anally pouring over our “Rank Order Lists,” to decide how we want to rank places.

And that’s the Match for you!

* Residency is the name of the training process you go through to become a doctor in a certain field. The length of residency depends on the specialty: pediatrics, internal medicine, and family practice are three years, others are four, some like plastic surgery or neurosurgery are seven. Internship is the name of your first year of residency, no matter what specialty. Most of the time you do your internship as part of your residency program, in some specialties like anesthesia, dermatology, ophthalmology, you do your internship separate from the rest of your training.

**There are some programs that will put you up in a hotel, or pay for your airfare, but these are rare. Often programs will have setups so that you can stay with a resident, however.

***There is a terrible thing called “Black Monday,” which happens the Monday before Match Day, where people who didn’t match at any program find out, and then have to enter “The Scramble,” where they quickly try to find an open residency spot somewhere, often not in their chosen field. (Knock on wood this doesn’t happen to anyone.)

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