Future Fellows Reflect on “The Match”

During my years in medicine, I’ve been privileged to give advice to undergrads, medical students, residents, fellows, and junior faculty as they consider future positions. I have heard myself dispense two pieces of pith again and again:

“At some point, you’ll stop going to the ‘best place’ you get into. You just have to decide if this is that point.”

“Ten years from now, the program you end up at will seem like it was destined to be your program.”

Even so, making these decisions, or having them made for you, is hard. Reading Dr. VanDolah’s reflection was a bit harrowing, bringing me back to my own college and residency applications. In the end, though, he seems wiser than what I expect are his years and I am sure that he and his family will thrive.

Adam Cifu

When my wife and I submitted our rank list for our fellowships (mine in adult cardiology, hers in pediatric hospital medicine), it was hard not to feel very proud.

We had interviewed across the country at 13 institutions, with names that excited our mentors as well as our families and colleagues. We had received so many offers we even turned some down. How could you not swell with pride when you were “one of a kind”? People we look up to as leaders in the field were telling us “we hope we can convince you to join us”.

For the first time in our entire medical education journey, it felt like we were in the driver’s seat. All those hours of research, the publications, and the leadership positions -- things we had done on top of our 60-80 hour weeks within residency -- were finally paying off.

We built our rank list with an eye towards institutional prestige and opportunities to grow our careers while balancing the considerations of our families and raising our firstborn daughter. Finally, on match day, we stepped aside from our busy morning rounds to open our emails together.

We stared in disbelief as we read the name of the program we had ranked 13^th.

For me, my match was with a community-based cardiology program, seemingly a far cry from the “ivory towers” that populated our list above. No fancy multi-organ transplants, no cardiac MRIs, no international clinical trials. I was crushed by a feeling of loss.

It felt like a gut punch after months of interviewing and being told how impressive our accomplishments were. There was this feeling we were finally cracking the world of “academia”. We were finally going to get in there and make a real difference. And now, it felt like it had all been ripped away.

As the days have gone by since match day, I can’t emphasize enough how we’ve come to realize how misguided this thinking truly was.

That night, we shared an emotional moment on the couch, before I refocused myself and saw my 5-month old daughter smiling at me. THIS is what truly matters, I thought. We were so fortunate to be matched together, a happy and healthy family, privileged to be trusted to care for the sick – better yet, in the areas of medicine we personally love.

As many of you know, this outcome is far from guaranteed. We were applying in competitive subspecialties with the added difficulty of couples matching. Of course, we feel incredibly grateful – we know others who did not match together, or even match at all. How could it be, then, we had felt so disappointed that day?

From the moment we decide to pursue a career in medicine, we are taught to shift our priorities. Test scores, research output, and networking are prioritized over sense of purpose, building meaningful relationships, and caring for each other and our patients. In fact, the current system even rewards neglecting teamwork and patient care as doing so can free up time for research, studying, and traveling to conferences.

Our sense of self-worth becomes so entangled with academic accomplishments that we can lose sight of the fact that we are caring for people at the most vulnerable moments of their lives. Having passionate and caring people working alongside us in those moments is infinitely more valuable than the research output of the adjacent basic science labs.

Like many things in medical education, the match process is hard to describe to those who have not experienced it. Most applicants spend in excess of $1000, sending their painstakingly crafted application to programs around the country, desperate to accrue enough interviews to ensure a successful match. The programs in turn must sift through hundreds (if not thousands) of qualified applicants to offer interviews for handful of spots. It is difficult to know how these decisions are made, but anecdotal experiences tempt us to be cynical that it is not done meritocratically.

Most of the programs I received interviews at had connections to my mentors. Almost half of the programs I applied to never even acknowledged my application. What if my application was last in the stack, read in 15 seconds by an overworked associate program director who needed to get out to pick his daughter up from school? What if it was simply “misplaced” and never read at all?

Somewhere along the interview trail, I received a prescient piece of advice: “It is more about you than it is about the program”. This extends far beyond the things about programs that you are told to consider: where you park; how much money you get for food; and what your call schedule is like. If you want to be something, YOU are the one that makes it happen, not the institution that you find yourself at.

For everyone who didn’t end up where they had hoped, I believe you will find a renewed sense of purpose and perspective. My wife and I have felt a sense of empowerment these past few weeks that I haven’t felt in years. For my colleagues in the “ivory towers”, I hope that you don’t lose sight of what this whole journey is about – caring for the patient. I’m not sure how we go about fixing this process, but I know it starts with refocusing our mindset away from academic achievements and back towards how we treat each other and care for the patient.

For all of you in medical school who are currently interviewing for residency, keep these lessons in mind as you build your rank lists, and your expectations, for match day. No matter where you end up, YOU are the most important part of your story. Your patients and your colleagues will be ecstatic to have you – if you are willing to give yourself wholeheartedly to them and not “call out” so you can get that next paper published.

Dr. Harrison VanDolah is in the final year of his internal medicine and pediatrics residency and will be a fellow in adult cardiology starting next year.

Photo Credit: Mehul Dave