Residency Match Day!
In this mini-sode, Tyler and Devan discuss match day; when fourth year medical students find out if and where they’ve matched for their residency years. It is one of the most intense, significant days in the life of aspiring physicians.
Transcript
0:26
All right, Tyler.We just had a really big event in the medical world happen.What was it?So, last week March, I guess it was on st.Patrick's Day, March 17th.All of the current fourth year medical students.Across the country found out if and where they were going to be spending their residency years, Yay.
0:51
Yeah, mostly, yay, mostly.Yeah.Well I like everything else that has to do with Healthcare it's way more complicated than I think a lot of people recognize her a lot of people even appreciate the complexity of it.
1:06
So let me walk you through the match process and then we can talk about some of the reasons why I'm currently obsessed with all the inner workings of the match.Okay, cool.So during the fourth year of medical school, so the medical school in the United States obviously has four years.
1:24
And then during the fourth year, students submit applications to residency programs.So postgraduate training in the specialty of their choice.There are dozens of not dozens, but many, many different types of residency programs so students can go into Internal Medicine which is kind of the most General, they Pediatrics will Be kind, they can go into surgeries and so they get an opportunity to kind of distinguish between the different sub practices of medicine.
1:56
What type of physician they want to be alright.So far so good.Yeah.And so they apply to all these different programs, different places across the country and residency.Programs are not necessarily tied to medical schools and so you could go to like a community-based Residency program.
2:16
So, say that I was Sitting practicing rural family medicine, for example, and I applied to a hospital or a hospital system in South Dakota, for example, that has a Residency program and I could go and do my training there and, you know, get very well trained to be a family physician in kind of a rural setting.
2:39
Yep.My whole family's from South Dakota so we get it.It's Paradise.So super competitive, right?Super competitive.Everyone's trying to get to South Dakota for the residency.Programs.But so previous tip covid students would have to apply to these programs receive an offer for an interview and then fly out to sometimes 10, 15, 20 different.
3:04
Oh my gosh, 20 different interviews.Well how can they who's paying for that?Well, that's a great question.The residency programs are not paying for it.Medical school is not paying for it, so it lands on the student.Oh no.So can be hugely Expensive disruptive to the fourth year of medical school.
3:26
And some students who don't have the financial resources or are wisely not willing to add that to their already.Massive student loans have to be really strategic about who they interview with and where they apply for, hmm.
3:43
And there's a lot of count coaching and counseling that goes in on the front end of this, from the medical school perspective, where you were looking at their grades, or Looking at their letters of recommendation and scores on certain really important tests to help coach them into what type of residencies, they would be competitive for regardless of whether they're interested or not.
4:07
So some of the really high profile really lucrative but also really good.Lifestyle types of medicine tend to be more competitive.So explain what what those would be I think I know.But what do you think?So some of them you would Assume based upon kind of The Prestige and the difficulty of getting into them.
4:26
So for example, neurosurgery for example or plastic surgery, those would traditionally very competitive also ones that you might not think about like Ophthalmology and dermatology and Urology.
4:42
Some of these a little bit more specific types of subspecialties are, can be really, really, really competitive to get into, is it?Because those Schulte's don't have like as much on call.You're not working 80 hours a week because there aren't like Dermatological emergencies.
5:00
Yeah, I think that's basically the, that's how I understand it.Some of them have our procedure based and so you're doing maybe minor surgeries in the office outpatient, maybe some inpatient surgical procedures and they're not a lot of call.
5:17
It's there's not a lot of emergencies, a lot of Independence.So those tend to have really good lifestyle and the pay is really high, even relative to other physician types of practice, interesting?
5:32
Okay?So all of the students who are currently fourth year, students in the United States.Plus, all of the graduating International medical students can apply to be part of what is referred to as the match.The match.
5:48
Oh, I like the sounds like a TV show.It's probably not as enjoyable as a TV show if you're in it, okay?Okay.So with a couple of Exceptions there a couple residency programs that do an early match and so if you're going into I can't remember all of the top of my head I think you're ology Ophthalmology and maybe another one, they do their match ahead of time and also if you're involved in the military so if you're matching into a military residency then those happen previously.
6:19
But for the vast majority of students who are graduating Fourth year they last week on Monday they got an email from the National Organization that runs it that tells them whether or not they matched into a Residency program.
6:35
Okay.So they have previously submitted a ranked list of all the programs that they would like to go to.And it can be as long as I think it can be, as long as they want, you know, up to 20, 25 30 programs, if they wanted to rank all of them and then the program.
6:51
So the residency Programs have interviewed hundreds sometimes dozens and dozens of students from across the country and internationally, and they have a massive list of ranking as well.So, both of these ranked lists, from the programs, and the students, in all of the Specialties goes into this algorithm and I love it, that this seems like the right way to do it, right?
7:14
So it matches them to and you may not get your first choice, and the program may not get their first choice, but the algorithm is Up in a way that most people get most of what they want.Okay.So this sounds a lot like speed dating, right?
7:30
Like, or do you want to be in a relationship with and do they want to be in a relationship with you?Like basically the same thing, right?Yeah basically and it happens for everybody all at the same time so on Monday they know whether or not they have matched or not.If they don't match we'll talk about that in a second.
7:47
If they could email on Monday saying that they did not match but if they got Got a match then they don't find out where their match is so where they're moving to and spending the next, you know, three, four five, seven years of training.
8:03
They don't know where that is until Friday at noon.So they have like four days of that's torture wai-wai-wait.I mean, if they matched, don't doesn't the algorithm know where they matched?Yeah, it does.But it keeps Us Secret.Why why?
8:20
So, what happens if you get a Email on Monday saying that you didn't match okay so at the same time students are finding out that they are unmatched so they didn't match to a program and also all of the programs that have empty spots, all find out at the same time and then it is really like speed dating for the next two or three days.
8:41
All the programs are frantically trying to find people to agree to come into their program and students are frantically trying to to decide where to go.So, there's lots of interviews, there's zoom and kind of the changes in medical education because of the pandemic are really have been really helpful in this way.
9:03
Because a lot of The Residency interviews I think, almost all of them are done virtually now.So the cost is lot less for students but still a lot of stress and and then at the end of it, you may not match and then you're kind of in this process where you're scrambling to and that's what it actually used to be called, is the Well they call it this soap now, which stands for, I do remember this verse.
9:29
I can't remember the subsequent open, I don't remember.That's basically it's a scramble and then they try to find a spot and then on Friday, at least at our Medical School.The other schools I've been associated with, there's a kind of a big party and ceremony and people will open it and some schools.
9:51
Will you get to open it in private and then you find out where you're going?Because it could be really, really good news or it could be really really disappointing news.Absolutely, right.Yeah.If it was the last one on your list or it's really not a specialty that you thought you wanted to go into, you had your heart set on Ophthalmology and suddenly, you have to be a dermatologist, how terrible?
10:13
But I mean, where's the, I want, like a cake that when you cut into it, like a gender-reveal party like I I want that kind of level of ceremony, but if you disappear but I guess, you know, those sex reveal parties can also be kind of disappointing depending on, you know, yeah, what you wanted.
10:31
So, so you might do it in private.That makes more sense to me, but then there's a big celebration.But how about these people are there?People who don't match?Even after the scramble there are, it's pretty, it's pretty rare, but it does happen to some folks and I think in, so, what I've seen in my experience is often students who are committed.
10:50
Is to wanting to be into that.Maybe an ultra competitive specialty will take a year off and maybe do a year of research or maybe a master's degree or something to make them more competitive and then go back into the process again and then try to rematch the next year.
11:09
Hmm.Wow so this is just incredibly stressful.You got a match because you have to do a residency.The you can't just even after four years of med school you are then a doctor you're a physician.You Get that degree but you have to do a residency, right?You can't just practice medicine without a residency, right?
11:26
You have to get a so doing a board-certified residency is necessary to get a license.I think in almost every state I'd be surprised if there's a state that doesn't allow that or that allows it not to happen.But yeah.So you have to go to a approved Residency program to get trained in the specialty that you are going to practice and some people matching new programs that there.
11:50
Not so interested in and they do a residency program and then they sometimes do another Residency program.Well, because they don't want to have their like sort of first real job until they're 40.Is that kind of the deal as two?People have multiple graduate degrees.
12:06
We get it friends forever.Yeah just keep going to school but but what so what did it so that happened all last week.So that was really fun.It's exciting.Kind of a big celebration for the students but But what was interesting about the match this year, is that there was one program or one type of residency, that previously had been really quite competitive.
12:30
And to the point that some students who didn't have a strong and numbers or whatever work discouraged from a even applying to that Residency program, but those types of programs because of the competitiveness of them.So can you guess what?It was anesthesiology.
12:48
No, but not too dissimilar, actually the the, it's emergency medicine, emergency medicine, the really intense one.Yeah.Right.And so it is, it was really interesting because the way that medicine is being practiced from like a business perspective is well, there's a lot of reasons why people are speculating that emergency medicine was very, very much.
13:18
Less competitive.Meaning that on that Monday, dozens hundreds of open spots in emergency medicine were unmatched because there weren't enough applicants to do that type of program.And so there's a couple of things that I've talked to people about why emergency medicine had such a hard year and some spots have even after The Scrambled.
13:42
The so process are still left unfilled.And I was reading about an I can't Amber where it was maybe in Illinois or Ohio.But there was a residency program in.Emergency medicine program that had let's say four or six open, first year residency spots and didn't fill any of them.
14:00
Oh no, yeah, so it's really Uncharted Territory for the for this specialty.Specifically.But all Specialties and there's a couple things that people are thinking about why this how to explain this.And so if you think about over the last couple of years during the Diabetic.
14:19
The folks that really bore a lot of the brunt of the uncertainty and the change.In the way that medicine was practiced, was emergency room Doc's.Yeah, that makes sense.That makes sense.Yeah, and so students, one hypothesis that I heard from somebody that I think is really smart and that I trust, she said that students are going in and rotating during their third year and sometimes in their fourth year through these emergency departments and seeing what a A challenging environment.
14:49
It is how there's a lot of change in the way that Partnerships and practices are being pot up.Bought up by private equity, and hospitals are cutting staff or asking staff to do jobs, or fulfill rolls out of necessity.
15:07
That doesn't really require an MD degree.So a mid-level providers, for example, nurse practitioners and Physicians, assistants are taking More and more responsibilities in the emergency room.And so for a lot of students they had a really, I don't know.
15:24
Not, it's hard to say, I haven't really talked to people who have gone through that, who made this decision, but it's it, I think it's plausible to think that such a difficult experience.As a medical student, would be discouraging for folks to go and say, this is what I want my life's work to be.
15:42
Absolutely, I would think that, that makes total sense to me.If you had if you went through the Edie as a med student on rotation during the pandemic, you wouldn't want anything to either.You would say this is exactly where I want to be or you could say absolutely not.
15:59
Yeah, and I think more people, well apparently our people said absolutely not where people said absolutely not and so therefore there are it really changed.The supply of medical students going into this into the match.
16:15
So.Oh goodness.So we does that mean like You know, ten years down the line, we're just going to have an incredible shortage of Emergency Physicians because this year, they just didn't match enough or what's going to happen now.So, this is a really big change for the specialty of emergency medicine previously.
16:36
Like I said, it was really competitive and so there was a lot of people being trained in it because it was its shift work, which means that you go in treat, the defeat the patients who are there and then you go home and you don't have Have and I'm on call.You don't have a long-term obligation to any patients.
16:52
And so, some people really like that, so it was quite competitive.So the short answer is we don't know what this is going to do for the practice of medicine.Specifically in emergency medicine moving forward, Well, we've got great.
17:08
No, terrible.Probably, there will be not good, right.We definitely need emergency medicine.It's super important in our country.I mean, probably every country, but especially a country, where a lot of people use it as like Primary Care.Exactly.And it's really going to be interesting to watch how this type of kind of ripple from the pandemic plays out over there, like you said, many years to come because really a nun.
17:36
Charted territory.Hmm.So that's what I'm obsessed about this week.Yeah, that's a good one.Well, congratulations to everyone who matched condolences to those who didn't.But maybe there's a spot for you in emergency medicine, Maybe
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