You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title.
You are a doctor.
But wait, you are not done yet.
Want to be a cardiologist, oncologist or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest rate on that six figure loan that you had to take out for medical school in America. When all is said and done, you are half a million dollars in debt and at minimum, fourteen years flashed before your eyes when you start your career as a specialist. Still want to be a cardiologist? Add in marriage, children, financial emergencies, and debt that was carried over from college, and you’ll find yourself struggling with the decision to pursue further training after residency.
If you were one of the lucky ones, you went straight through all of your training. But most have had to do an extra year or two, or three, working in research to become competitive applicants. The way our health care system is devised, all medical students and foreign graduates must match into a residency. And if you want to become a specialist, you’ll have to match into fellowship. It’s no guarantee that an applicant will match into either.
What is the match?
Since 1952, one day in mid-March is designated as Match Day, a day when medical students in the United States open emails or letters that hold the name of a single residency program somewhere in the country to which they have been assigned. For medicine fellowships, Match Day is the first Wednesday in December.
The match is kind of like dating. The ever so popular online dating website Match.com doesn’t guarantee you are going to find your husband, but you do it because if you want to get married you have to go out on dates. You put your best self out there. You perfect your online dating profile with photos of your best angle and a summary that makes you an appealing catch. You wait for an offer, a date. You go on the date, which is like an interview, and wait to see if there will be another. Maybe it’s a match, and maybe it isn’t.
Match Day is the culmination of years of work. Years of studying and taking examinations, months of preparing applications and interviewing, and weeks of contemplating over a final rank list of programs. Starting in the summer of third-year residency and ending in December — applicants submit their top pick of programs, ones that offered them an interview, to a central hub in Washington, DC. At the same time, fellowship programs submit their list, ranking applicants they interviewed based on their letters of recommendations, research publications, work as a resident and board scores. Finally, the computer spits out the name of a single fellowship program, using a very complicated matching algorithm.
Just when you think you are on the way to the fellowship of your dreams in the specialty that you’ve worked so hard all those years to achieve, think again. If you don’t match, which hundreds to thousands don’t every year, you can’t try again until the following year. Even for those that match, however, the news can be overwhelming and sobering. Spouses and children may have to move across the country because mom or dad’s match results displaced them thousands of miles away from their home. Expectations of a new city or state may be the only thing that is negotiable, because the match results, unfortunately, are not.
For myself, Match Day this year was a devastating reality that a system has the potential to dictate our future lives as physicians and the lives of the ones we love. Was the system of training young doctors, the system that I had surrendered myself to when I entered medical school, about to tell me that I was not going to become an oncologist? I was one of the 800 applicants for a position in a training program that takes only two or three new fellows per year, max.
The day finally came: Match Day for fellowships, 2014.
I was on rotation in the neurology intensive care unit anxiously waiting the moment when I’d find out what program I was going to for fellowship. The minutes seemed like hours for my email to come with the match results, but as I waited, I thought about my life up to that moment.
I’ve wanted to become an oncologist ever since I was a teenager, when I lost my mother to breast cancer. Emotionally distraught from the death of my best friend, I found myself turning to education for guidance and her physicians for mentorship. The daughter of a Polish immigrant, I worked two jobs to pay my way through school. With two younger sisters to care for, and a full-time school load, I managed to defeat all the odds against me, showing those that have ever doubted me that, I too, can become a physician. With eight years of schooling behind me and almost three years of residency down, I was ready to move to the next step. Oncology.
Match Day held the fate of my professional career. With two friends from residency at my side, I opened an email delivered to my inbox at twelve o’clock on the dot. In a second’s time, I was transformed from a resident with the dream of becoming an oncologist to being devastated and without a fellowship for next year. Statistically, I should have matched, yet while I was selective on my final rank, I still was left in disbelief. I did not match.
With tears streaming down my face, I sat there in complete shock that a system, one that I put my heart and soul into, would mark such disappointment. I had it all: research, publications, ongoing quality improvement projects, leadership positions and letters of recommendation from great mentors. After an hour of coming to terms with not matching, I sought after five unfilled hematology-oncology positions in the country that were left after the match results.
The days that followed marked the longest and most heartbreaking of my residency until I began receiving offers to interview. What came next changed the path of my life. I knew that, in fact, my life was on track, and I was right where I needed to be. I accepted an open position at a prestigious university in Washington, DC: the hematology-oncology fellowship of my dreams.
Going from unmatched to matched in less than 72 hours taught me resilience in the face of adversity. As physicians, we too face many fears, just like our patients.
What will become of the fellowship match in the years to come?
An increasingly more competitive field, oncology fellowship is one of the most sought-after fields in medicine. With increasing Caribbean medical school class sizes, new medical schools popping up all around the States and approximately 5,000 new medical doctors each year, when will supply catch up to demand? How quick will it take to have a shortage of specialists?
In the 2013 fellowship match, the National Resident Matching Program (NRMP) reported 9,297 applicants that participated in at least one of the 55 specialties that offer a fellowship position. To demonstrate the amount of competitiveness within the fields, let’s take a look at a few specialties. Hematology-oncology had a staggering 689 applicants, matching 502 for 517 spots. 187 young physicians went unmatched. Pulmonary-critical care: 753 applicants for 489 positions. There were 486 positions filled, 3 unfilled, and leaving 267 unmatched.
Is your childhood dream to become a cardiologist? A whopping 1,106 residents applied for cardiology in 2013, and almost 30 percent did not match.
So if you are applying for fellowship or thinking of applying, here is what I learned from the match.
Fellowship takes more than a deep desire and a good resume. Decide what when wrong with your match. Start early, research your options, enhance your exposure in volunteer work and conduct clinical research projects. Most important, get yourself published! Contact the programs that are in your top, and try to rotate there. Do not limit your application geographically; that is a common misstep. Did you only apply to competitive programs like me? Rethink that if you do not want to reapply the following year. Do you have gaps in your knowledge or resume? Take the time to address them, and you’ll be well on your way to the fellowship of your choice — the first or second time around.
It all comes down to our lawmakers. The positions available in the match are out of our control. Caps on graduate medical education funding may be the ultimate limiting factor for everyone to get a fellowship position that wishes too. The bottom line: It may get drastically worse. This year I went to Washington, advocating for physicians on Capitol Hill. What I found was a rude awakening that the federal government is proposing to cut $11 billion dollars over the next decade in its fiscal 2014 budget. What does this mean? This could seriously limit the access to care for patients that are in need. You may be a phenomenal physician and would make a phenomenal cardiologist, but with limited spots, more and more will not match. The match imbalance — applicants vs. positions — is not changing anytime soon. What you can do is be proactive in health policy. Join the AMA or the American College of Physicians and advocate for yourself and your colleagues.
You will end up where you are meant to be. The last thing an unmatched resident wants to hear is, “It was meant to be.” But once you move through the inevitable shock and pain of not matching or matching somewhere in the bottom of your rank list, life does have a way of working out. If you don’t match, you will eventually. Maybe it will be next year, or maybe the year after. You will find presence in your specialty. Not matching is not a catastrophe, and it often works out better the second time around. Perhaps you will match into an unfilled position as I did. Or perhaps you will find the experience benefited you in ways that you may have never expected, and match the second time. Disappointment is the key ingredient of any professional career.
Remember, you are never alone.
Danielle Krol is an internal medicine resident and on staff, ABC News Medical Unit. She blogs at Daily Dose MD.