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Bring on the Mimosas

If you take all the drama of Bachelor, add 10x the madness of KUWTK and sprinkle in the suspense of who will win the Oscars you will not come remotely close to the anxiety caused by the residency match process.

Tarun and I have been through this twice and each time it has aged us and driven our kids batty. If you have doctor kids you know what I am talking about. If not, read on.

Matching is the process by which a graduating medical student lands a residency position. “A” position. One single position at best, none at worst.

Imagine if you were applying to colleges and you had to pick a major upfront without any option of changing it later and only ONE college offered you admission. It may not be a location you want or it may be your last choice but you have to go there because you are contractually bound.

That's matching in a nutshell. Let me use Josh's story to explain the insanity.

His matching journey began at the end of M2 - second year of med school - when he took Step 1 of the US Medical Licensing Exam (USMLE). His score in this exam locked him into the specializations he could shoot for. It's a brutal exam that covers the content of M1 and M2, requires months of prep and gallons of Mylanta.

A year later he took Step 2 of the the USMLE. The trick here was to do as well in Step 2 as he did in Step 1 to avoid shooting himself in the foot on competitive residencies. In the meantime good grades, recommendation letters, and academic honors had to accumulate in his favor. Before we were grounded by the pandemic, M4s used to visit other schools to do "away" rotations (think of it as an internship) in their preferred specialization. This was a way to court the programs.

Last fall, Josh applied to 100+ otolaryngology residency programs. Yes, that many because there are more applicants than oto positions. Fear came naturally and in abundance.

The pandemic threw a massive monkey wrench into his professional life. Away rotations were canceled as were in-person interviews. So now he was stuck with impressing programs without having face-to-face time with them. And worse yet, committing to spending five years in a location he has not visited and with colleagues he has not met except for a bit on zoom.

This year, the National Residency Matching Program (NRMP) - the organization that manages the match process - came up with the idea for applicants to signal their favorite programs with "tokens". So now, Josh had to figure out which programs to token even before speaking to them.

Cue the anxiety.

After submitting the apps, he had a nail biting wait for interviews. Otolaryngology is so competitive that every program is considered a “reach”. In the middle of interview season, Josh got very ill and still had to take the Step 2 exam and do interviews because slipping on his commitments would swiftly eliminate him from the match process.

Cue even more anxiety!

In early March, Josh submitted his rankings - he numbered his interviews from 1 to n, 1 being his top choice. Then, the residency programs ranked the candidates they interviewed with 1 being the candidate they want the most. These rankings were fed into NRMP's algorithm which finds the best fit between applicants and programs. Lore has it that this algorithm favors the student. Try telling that to the kid that comes away unmatched!

Then came March 15th, 11am. Josh sent us this photo in the moments leading up to this. Anxiety had turned into ambivalence into palpitations and all that had turned him into an ostrich!

At the appointed time, he got an email from NRMP - congrats you matched. Others got an email saying sorry you did not match. Four days later he found out where he matched. A life-altering event played out in slo-mo.

Those who didn’t match had to rapidly switch to another specialty like internal medicine where positions go unfilled. That’s like loving physics and being forced into biochemistry.

After 8 years of college and medical school, Josh came down to one choice on his first job. Simply mind-boggling.

This morning the mimosas have got our little guy - the one with the attention span of a fruit fly in his early years! - off to a fantastic and full day of day-drinking in celebration of becoming a head and neck five years.

When you have someone in your life going through the match process, please give them heaping amounts of unconditional love because the whiplash is severe!



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