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The Match

I wrote this piece a few days ago as I’ve been dealing with my anxiety about the approaching match. I have anxiety because last year, we did not match, and had to scramble. This year, I don’t want to go through that again, but I’m sure I’ll know someone who wil, and I remembered there were several people that helped us understand how the scramble process worked, and gave support through that time, and I wanted to return the favor.

This is it. Four years of medical school, dozens of exams, hundreds of patients, and night upon sleepless night of study. It’s all come down to this: The Match! Many people think this is the most important day on your medical journey, but let’s ratchet back slightly and call this a key date, akin to taking your MCAT, getting accepted to med school, and passing your Step 1 boards. Surprisingly given the importance though, many people don’t know the full process. Even if you are a spouse or significant other of a medical student, you should know the process, for peace of mind, and to support your med student. Also, since this is where you’ll spend the next 3-5 years of your life, and perhaps longer, residency deeply impacts your life too.

Let me start off by saying that the following information is based solely on my experiences, research, and conversations with fellow medical student spouses. I’m in no way an expert, so please do your own research. Ask existing residents, talk to advisors at your medical school, or call the AOA/NRMP. Also, in totality, what you are about to read applies to DOs, and in part to MDs. If you are a DO, you can participate in both the AOA match, and the NRMP match for allopathic doctors. My wife is a DO, therefore my perspective is tuned to that view. There are many variables in this process, too many to list them all. But as an example, you could be a 4th year med student applying for the match for the first time, or a 1st year resident applying again after unsuccessfully matching last year, or changing specialties. You could be applying for 1 or multiple specialties, such as Ob/Gyn, and Family Medicine (as a backup). You could be applying by yourself, or for a couple’s match with your spouse. Finally, this process is always evolving, so please refer to the AOA and NRMP websites for the latest information. This year, the NRMP has responded to problems with the scramble by implementing a new SOAP process. I truly believe the match tries to be a fair and even system.

1. Before the match
There are many steps before the match, but in quick review, you will have taken step 2 of the boards, chosen a specialty, submitted the ERAS, applied to several residency programs, accepted some interviews, participated in said interviews, and determined a rank order list (ROL) of residencies to which you would like to match. There are a hundred specific nuances that I will gloss over for the time being, such as specifics to the military match, how to do a couples match, where to interview if your specialty requires traditional year residency, what your plans are for fellowship, working in under served areas in the hopes of receiving loan forgiveness, etc. However, at this point you should have determined what programs you would like to attend for the next 3-5 years, and in what order you prefer. You might also have received specific feedback from the director of programs which will rank you high on their list. Not all programs will directly inform applicants of their preferences, but some do to better ensure they get their top matches. Remember, the rank process favors the medical student, not the program, and the rank is very competitive.

2. Rank list
For most people, the DO match comes first. There can be exceptions: for example, the Urology specialty performs allopathic match in January. By the end of January, your ROL should be submitted on the AOA match website (http://www.natmatch.com/aoairp/). This date for 2012 is January 27th. Once this date has passed, if you have submitted an ROL, you cannot withdraw from the AOA match. And remember, the match results are binding!

3. The DO match
In 2012, the match takes place on February 13th. Sometime in the morning, applicants will receive notification that they have matched or not, and if so, with which program. If you match, you will be automatically removed from the NRMP match, and you must accept the position you have received. The residency program is obligated to send you a contract within 10 days, and you are obligated to sign and return within 30 days. Again, there have been exceptions where people have backed out of their contracts despite the match results, but these are rare. Also, once you sign the contract, your new residency program will have numerous more steps you need to complete, like background check, licensing paperwork, application, etc. This is akin to the paperwork you would complete with just about any new job.

4. Rank list – NRMP
Just like the DO match, the MD match has an ROL you’ll need to compete. In 2012, the date is February 22nd.

5. The MD match
The MD match differs from the DO match in that on match day, applicants will only find out if they matched or not, but they won’t find out where they matched until 4 days later. Technically, the NRMP refers to the latter date as Match day, but I would rather call it Reveal day.

6. Scramble
If you are here, there is one piece of advice you must follow above all others: STAY CALM! Trust me, my wife and I were there last year, and we’ve had friends who were there in previous years. We know the feelings, the anger and shame of not matching, the frustration at the complexity and unresponsiveness of the system, the confusion over the process that was never well explained, the lack of resources to use, people to call, and the fear of ultimately never finding a position. Aside from calm, you can combat these feeling with 3 simple things: be informed, be prepared, and have support on hand. Inform yourself of the process by reading this post, checking the NRMP website, talking to your school and residents who have previously scrambled. Be prepared by have tools at hand: cellphone/landline, fax machine, computer with steady internet service, lists of programs, current copies of your CV. Get the support of your spouse, family, friends, peers, and have them ready to help you. They might need to make calls, watch the kids, prepare meals, or just be a comforting presence.

The NRMP has implemented a new scramble process called Supplmental Offer and Acceptance Program (SOAP). I think SOAP is an apt name for this process, because it is much cleaner than previous scramble years. Here is the official process for SOAP (http://www.nrmp.org/soap.pdf). I like the new process, because scramble is performed exactly like match. Only unmatched applicants receive the list of unfilled positions, just as in previous years. However, now all scrambling will be performed through ERAS. Scramble will consist of several rounds of applicants and programs submitting ROLs, mini-matches being performed, and offers being made. Applicants will have a short time period to accept the offer before it expires. Then another scramble round will begin. Please read the SOAP document for specific dates and times. The SOAP documentation clearly states that applicants will not call/fax/contact programs, and likewise with programs contacting applications. Given that this is the first year of SOAP, I would not expect that policy to hold 100%. But if all goes well, the process will be smooth and efficient.

Even after scramble completes, some applicants will remain unmatched. I would strongly suggest you seek guidance from your school if this happens. If you are a DO, please remember that even a month after the DO match was completed, there may still be DO positions unfilled. These positions should be available on the AOA website. You should call the programs directly and submit your application.

I can look back on the 2011 match now with calm and clarity. At the time, our feelings of frustration and despair were palpable. Aside from not matching, the ERAS website crashed at the moment the scramble began, and nobody could access the unfilled position list for hours. However, based on rumors amongst peers, there was fear that some applicants at other schools had access to the list and were given a distinct advantage. Positions in Ob/Gyn (my wife’s chosen specialty) filled within the first day, and we hadn’t received a single call. In fact, we didn’t receive any calls the first 2 days. Then all of a sudden, we received 2 calls at the same time, and within 2 hours had interviewed over the phone and received offers for traditional year residencies. It happens just that quickly. But it’s scary when you are going through it, and when you look at the numbers. There are more applicants than there are positions. But be persistent, and you will find a position. A traditional year residency will allow you to begin training, and reapply for a specialty next year. Don’t forget about family medicine, which has more unmatched spots than any specialty.

Above all, remember to stay calm.

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One thought on “The Match

  1. Hey Drink,
    Great piece. I really liked it. There really should be a better system for the scramble, since that’s exactly what it is. Your description of how you felt when you didn’t match is spot on, even there really is no way to describe it, especially as the spouse. Talk about feeling absolutely helpless.
    Good luck on Monday. I’ll be praying for both you and Sheila!

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