hide captionPenn State College of Medicine students Nina Mani (from left), Linda Myers and Showieb Shuja react with excitement after opening the envelopes that disclosed the names of the hospitals or other medical centers where they will complete their residency programs.
For many fourth-year medical students, the future arrives, sealed in an envelope, during the third week of March. On what's known as Match Day, med students find out where they'll spend their residencies. It's a nerve-wracking wait for many that has played out on med school campuses since 1952.
Retired Dr. Sherwin Nuland, who practiced as a surgeon for 30 years, remembers his Match Day. It fell on just the fourth Match Day ever, in 1955. He tells NPR's Neal Conan that the program was confusing in its early years, and students "were advised with a great deal of erroneous information."
Nuland applied to Peter Bent Brigham Hospital in Boston, which is now known as Brigham and Women's, and Philadelphia General. "I ended up unmatched," says Nuland, "and there I was, high and dry."
But when one of his classmates decided to switch his specialty, it left an opening at Yale-New Haven. "And the next thing I knew, I got a call from the chairman of surgery saying almost these exact words: 'Nuland,' he said, 'would you like to join us next year on the surgical service?' "
"Well, at that point," says Nuland, "I would've taken a midwifery internship at Hoboken lying-in or something like that. And I said, 'You bet I would.' And it was ... one of the smartest things I've ever done."
Dr. Atul Gawande of Brigham and Women's Hospital in Boston, who also teaches at Harvard Medical School, met his Match Day in 1995. "It's a strange moment," he remembers. "You stand there in a room with all of your fellow medical students, getting handed a white envelope that tells you what city you're going to live in for the next — for me, seven years of my life in surgical training."
Gawande, who attended Harvard Medical School, matched at Brigham and Women's to the great relief of his pregnant wife, who hoped to continue to see her obstetrician in Boston.
Now, Gawande is on the recruiting side of Match Day, so he understands the process from both sides. "The surgical residents, for example ... will travel to 10, 12 cities to interview," he says. "You kind of size up the joint and then decide, boy, you know, is this somewhere I want to be?"
But it's a tense time for the hospitals, too. "We're all in the selling process," says Gawande, "trying to convince them that, you know, hey, we're all happy people here, and we'll make you great at what you do."
The interviews aren't strictly business, either. "I think the biggest fear that people have is that they're diving into ... a place that they don't want to be," says Gawande. "Probably the most important part of the interviews is that the night before, we make sure that the other residents take them out to a bar somewhere around town and just get them a couple of drinks and let them get to know that they're not just going to be working with a bunch of insane people working 80 hours a week who don't have any kind of life."
hide captionBoston University medical students Miriam Shiferaw (left) and Nawal Momani check letters together to find out where they have been accepted for their residencies during Match Day in 2007.
Boston University medical students Miriam Shiferaw (left) and Nawal Momani check letters together to find out where they have been accepted for their residencies during Match Day in 2007.
But what about doctors who don't match, and who don't get a lucky call like Nuland? They learn their fate a few days early, to spare them opening an empty envelope, and "go into what's called the scramble," explains Gawande.
Formally, the scramble is the Supplemental Offer and Acceptance Program, or SOAP. Unmatched doctors are "put together with hospitals or universities that have not filled their quota," says Nuland, "and they have a period of two hours in which to decide what to reapply to." Later that week, they learn where they've been rematched.
Still, the initial rejection can be a blow to the ego. Unmatched doctors might want to take a page from Nuland's book. "Surgeons, you know, tend to be very narcissistic," he says. "I couldn't imagine [Brigham] would turn me down — impossible to believe. And, of course, they did." But, he says with a laugh, "I never learned from that lesson. I've remained narcissistic ever since."