Monday, March 14, 2016

The Perfect Match

So today is Match Day 2016!  To those of you in the world of medicine, you know exactly what that means.  For those of you who aren't, it's only one of the biggest days of your medical career (in addition to the other day this week when you find out WHERE you matched...).  For Jonathan and I, we are exactly one year away from our own Match Day.  We will be beginning our search for "The Perfect Match" this fall.  Who am I kidding??  We've already begun the process of finding The Perfect Match, and all the preparation will come to fruition in the fall!  This is such a huge day for med students.  It's WAY bigger than Graduation Day if you can believe it.  Going into medical school, I honestly thought that the walking across the stage, getting your hood and diploma, and being able to call yourself Doctor was the biggest accomplishment.  Don't get me wrong, it surely IS an accomplishment!  But the hood and the diploma and the letters after your name all serve to "sweeten the deal" of being hired for a residency program.  That's the big prize at the end of this whole shenanigan...

Today I find myself with a bit of a perpetual adrenaline rush as I wait to see those Facebook posts from friends in the 2016 match saying they matched.  Today they will find out IF they matched...Friday they find out where.  It's so convoluted and I know I've tried to explain it about a million times to those of you who are "out of the loop" when it comes to the process of medical school and residency matching...

This blog is entitled "Thinking Positive".  It was a bit of a pun when I started it because we were thinking positively about our process of IVF and hopeful pregnancy, but we were also thinking about a positive pregnancy test.  So in the interest of continuing the theme of "Thinking Positive" (since thinking about Baby Womack #2 is still a good ways away...), I have decided that I will swing the pendulum in a different direction for a hot minute.  These next 12 months are going to be crazy!  Exciting, nerve wracking, stressful, joyful, and hopeful.  Just like our 2014 and 2015 were!  So our positive thinking for this period of time will be directed at the Match process for Jonathan's residency.  I can't believe it's already time for this!  And since many of you are probably totally mystified by the whole process and have no earthly clue what will be going on in Womack-ville for the next few months, I decided my first post would be an enlightening one on the matter.  So buckle your seatbelts and and get your pen and paper ready (haHa!)'s Medical School and Residency Matching 101 via Rachel Womack...

Step 1
Complete Basic Sciences

This is what we spent 1 semester in the Bahamas and 4 semesters in Dominica doing.  This is classroom learning basically.  It's LOTS of lecture, LOTS of reading, dissection of cadavers for Anatomy, looking at slides for pathology, and practicing with standardized patients on taking a history and physical and writing up a patient note.  It's brutal and grueling and not for the faint of heart.  It's NOTHING like undergrad, NOTHING like getting a Master's degree, and it's designed to weed people out in a bit of a cutthroat kind of way...

Step 2
Clinical Sciences (Clerkship)

Long story short, this is 2 years of learning to be a resident without getting paid.  You have to take rotations at an assigned hospital in 6 core disciplines (Pediatrics, Obstetrics and Gynecology, Family Medicine, Internal Medicine, Surgery, and Psychiatry) first.  These "cores" are anywhere from 6 weeks long to 12 weeks long.  After your cores are done, you take an additional load of "electives".  There are a few requirements about these, but they are designed with some freedom of choice so that you can explore different aspects of medicine and cater your clinical experience to what you hope to find a job doing.  These electives are things like Endocrinology, Cardiology, Oncology, Surgery sub specialties (i.e. ortho, neuro, cardio thoracic, plastics, etc.), Hematology, etc.  These electives are usually 4 weeks long.  During your electives you can also do Sub-Internships in the field you are hoping to match with.  These sub-I's help get your foot in the door with the hospital you rotate through and also give you a more intense experience more like a real residency (i.e. with a lot more responsibility).  This is where we are right now in the process.  Jonathan is done with cores and has completed 4 of his elective rotations.  He has 6 more to complete before he is officially Dr. Womack in November!

Step 3
Pick a Specialty and Research Residency Programs

During your Clerkship (see above), you decide on a specialty.  It's not an absolute requirement that you make a final decision before applying to residency.  You can always apply for programs that allow you one year of what is usually called "Preliminary Medicine" which is a broad spectrum year of residency to help you zero in more on where you want to settle.  And again, choosing a specialty for a residency is not a "signed in blood" thing either.  You can still change your mind and reapply later if you get into a program and find out it's really not your cup of tea.  Jonathan has decided to go into Internal Medicine (what's that you say?  Think Scrubs.  Hospital wards and ICU's with emergent patients and maintenance care at the hospital with an additional element of primary care outpatient work...).  From Internal Medicine he can stay more on the "categorical" side (i.e. broad spectrum with training in all IM fields <cardiology, geriatrics, endocrinology, oncology, neurology, ear nose and throat, etc.>, or he can choose to specialize and after 2-3 years of categorical medicine he can further focus more directly on one sub-specialty).  Researching residency programs is a HUGE undertaking.  Mad props to our friends who are single med students because I'm doing most of the leg work for Jonathan on this and it is A LOT of work.  I can't imagine how difficult this part of the process must be if you have to do it all yourself while you're still working through your Clerkship.  You have to go through FREIDA (Fellowship and Residency Electronic Interactive Database Access) and ACGME (Accreditation Counsel for Graduate Medical Education) to find out what hospitals in the country offer a residency in your chosen specialty.  My strategy has been to put every single program I find onto our list (excluding the ones in states we aren't interested in living) and whittle down from there.  I've been using a few criteria for taking programs OFF the list: #1-if they don't accept foreign medical school graduates (even though Ross students graduate with the same credentials as any other medical student in the US, since the basic sciences are taken in a foreign country, their graduates are considered foreign graduates), #2-if they haven't accepted Ross students in the past 5 years), #3-if their website is bunked.  From there I then look at what their minimum Step 1 score requirements are (Jonathan's scores are substantially higher than every single IM program's minimum requirement that I've come dude!), what the salary schedule and benefits look like, and what the curriculum and schedule looks like.  We are shooting for a magic number of programs to apply to, and that magic number is different for everyone.  Some statistics say most medical graduates apply to an average of about 36 programs (for Internal Medicine that's different for every specialty).  For foreign med grads, they recommend applying for a good bit over the average, but the number is really up to you.  If you're feeling lucky, maybe you only apply for 30.  If you're wanting to bolster you chances, maybe you apply for 80.  Bottom line is that you're shooting for 8-12 interviews optimally.  More on that later...

Phew!  Okay, are you still with me?? ;)  Hang in there...

Step 4
Apply for Residencies Through ERAS (Electronic Residency Application Service)

Thankfully you don't have to apply individually for every single residency program you are interested in applying to.  All US residency programs (other than Urology programs) use ERAS.  ERAS is an electronic system that allows you to build your application generally speaking and then each program you are applying to can access your information through your profile rather than filing through mounds of paperwork.  We get to buy our ERAS "token" very soon, and that's when we start building our profile/applications.  Thankfully doing it through ERAS means the applications are a lot less expensive.  Of course the cost is dependent on how many programs you apply to and in how many specialties (it's recommended that you stick to just one, but some people apply for IM or Family Medicine programs AND more specific programs like Neurology or Pediatrics to name a few...).  Jonathan is wanting to apply to about 65-70 programs (which I think is nuts with his scores as high as they are, but he gets to call the shots on this one!), so our ERAS bill is going to be somewhere in the ballpark of $2500ish and that's just the applications themselves.  We haven't gotten his personal statement and curriculum vitae reviewed, that doesn't include the ERAS token purchase, and we haven't paid for interview attire, transportation, travel expenses, etc.  So it's PRICEY (goodbye student loan reimbursement for the Fall...)!  Applications are submitted September 15th and programs begin calling for interviews around November 1st...

Step 5
Programs Review Applications and Request Interviews

For this part, there is a bit of an algorithm for every program.  They plug their requirements into their system which then quickly files through thousands of applicants to their program and gives them only the applicants who meet those requirements.  From there, they review more specifically your CV and your personal statement and any other person specific criteria and whittle down the bunch even further before calling for interviews.  A program may have anywhere from 5 spots to 50 spots and they interview as many as they feel like interviewing.  You could be one of 200 interviews for 15 spots, or it could be more or less respectively.  This is uncharted territory for us, so I only know what I've read and seen up until this point.  Programs give you a few options of dates for your interview and you can accept or decline their offer of an interview.  If you decline, you cannot match with that program.  Likewise, if you don't get called for an interview, you can't match there.  Also, even if you interview with a program, it does not mean they'll offer you a position or "rank" you high on their list (more on that later...).  I've found that many programs will give you free or discounted room and board for your interview stay, but you have to pay your own way to travel to the site.  Greysen and I will be traveling with Jonathan to each of his interviews and we will be exploring the city and the housing options while we are there.  The interviews are as much about the program getting a feel for you as they are you getting a feel for the program.  It's all the process of finding The Perfect Match for you (and your family) AND for them.  Tricky, tricky...

Step 6
Accept Interviews and Rank Programs

So now, you go to interviews.  You speak with the current residents and the attendings, you get a tour of the hospitals, some programs have you go on grand rounds with them, and most have formal and/or informal dinners where you get to mix and mingle a bit (lots of these welcome spouses and for the ones that do, we will be bringing my mom or Jonathan's mom along to babysit Greysen while Jonathan and I attend the functions).  *Some* programs will offer a residency spot immediately, but if you decline their offer, they won't extend it again.  *Some* programs will tell you to rank them high and they'll rank you high. *Some* programs are more cryptic.  After you've taken all your interviews (interviews are done by the end of January), you submit your "rank order list" in February.  This is when it gets a little dicey again.  Another algorithm!  Let's say you interviewed at 10 places.  You rank those programs from most desired to least desired.  The programs you interviewed with rank their interviewed candidates.  Let's say they interviewed 50 applicants, they rank then 1-50 from most desired candidate to least desired.  Everyone submits their rank order list in February.  Then the computer system shakes the whole thing out and according to your rank with a program and their rank with you, you either match or don't match.  It's not *really* as cutthroat as it sounds, but it's definitely stressful.  You get one match and only one match.  If you turn it down, you have to wait until the next match year to try again...

Step 7
Find Out About Your Perfect Match!

In the middle of March, you find out first *if* you matched.  There's some hoopla that happens if you don't match initially.  They used to call it "The Scramble" which meant programs would then go back through the list of applicants that didn't match and see if they wanted to take you on in one of their unfilled spots.  I don't know if this still happens or how it happens if it does, but we will just Think Positive (see what I did there?) and hope for a "first round draft pick" (if you will...).   A few days after you find out *if* you matched, you find out *where* you matched.  And hopefully that match is The Perfect Match! Once you match, you get specifics and most programs start either June 1st or July 1st.  For Jonathan, his residency will last 3 years and then he will be in his own practice (more on this in a different post...).  Other programs are shorter or longer depending on your specialty of choice.  We will then travel to wherever we matched and find a place to settle in!

For your own references (for those of you still with me here...), so far we have places on our list literally all over the country.  12 programs in Texas, 7 in Massachusetts, 6 in Arizona, 2 in Oklahoma, 1 in Kentucky, a few in Alabama, some in Tennessee, a couple in Kansas, 3 in Rhode Island, etc.  It is a total toss up as to where we end up!  Where do we want to end up you ask?  Honestly, we are keeping a VERY open mind (as I've been told to do).  We are embracing these three years as an adventure and we are hoping and praying that wherever we end up will be our Perfect Match.  So GOOD LUCK to everyone matching in 2016 and stay tuned for our Great Adventure in 2016-17!

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