For every fourth-year medical student, match week arrives with an email from the National Residency Match Program (NRMP). Some students receive a message congratulating them on matching, assuring them the location of the program will be revealed at the end of the week. Others receive a message stating they did not match with a residency program and are contacted by their administration regarding instructions for the Supplemental Offer and Acceptance Program (SOAP). Unmatched applicants submit a maximum of 40 applications to the programs with remaining open positions, and all faculty, staff, and students are prohibited from contacting these programs. This process lasts for three days, in which three rounds of offers are sent to the students. If a student still doesn’t have a position after this, the scramble begins. This is when the very last remaining positions are made public and the application process is basically a free-for-all. Anyone can contact any program regarding a position. Emails and phone calls are sent to all programs, most of which respond with “the position has already been filled,” if they respond at all.
I’m explaining this because the majority of medical students, fortunately, do not experience this process. I did. I experienced the pain of rejection at every point in this process. I experienced the disappointment of not being ranked high enough by my home institution to merit even a preliminary position there. I felt ashamed. When I didn’t even match in the SOAP, I thought that my home program would reach out to me and ask if there was anything they could do to help. Due to an unfortunate oversight, this did not occur. I felt as though I was deserted in unknown territory. On Friday, the day after the scramble process had started, I put my pride aside and reached out to the program coordinator, letting her know I hadn’t matched, that I was certain she already knew, but asking if she had any advice anyway. She immediately emailed back stating that no one in the department had been aware of this, that she wished I had reached out sooner so she and the other surgical faculty could have been making calls on my behalf. She didn’t know anyone with remaining positions by this time, but she sent some emails to close contacts and we waited anxiously for replies. On Monday, we got a lead: there was a recent change in a program that resulted in the availability of 2 preliminary positions that had not been previously advertised. I immediately sent my application there but had very low expectations at this point. A call came later that afternoon – the program director, wanting to discuss my application. After a week of interviews and conversations with my home institution faculty, they had offered me a position as a preliminary surgical resident (prelim).
The closer July 1st came, the more anxiety I experienced. I reached out to my mentors, who gave me some great advice on how to stand out as a prelim. Never be unreachable, communicate, be the first one there and the last to leave, dominate the in-service exam, and do all of this while maintaining a low profile. But no one talked to me about the constant insecurity I would feel, not knowing if I would be taken on as a categorical or if I’d even have a job the following year. No one told me that I would feel like my career was over every time I made the slightest mistake. No one even told me it was normal to make mistakes and that’s how we learn. I’m sure some of this could have been insinuated from morbidity and mortality (M&M) conferences and didactics and feedback sessions, but never in my life had I doubted myself so frequently. I wasn’t the first person there and the last one to leave because someone told me it would look good. I was at the hospital constantly double-checking my work and going through charts and orders to make sure nothing went wrong, terrified of what would happen if my patients had a poor outcome. That year, I was the first intern to present at M&M conference. I was terrified, but supposedly did a decent job. I also made a lasting impression on a visiting surgery department chair by smashing a door into his forehead, causing him to bleed all over the hallway and end up concussed. The following week, signs had been posted on the door, handles removed, and windows inset so that one would always know if someone was on the other side. So much for keeping a low profile.
I still had to interview for categorical positions. I only had two: one with the program where I was currently a prelim, and one across the state. At my outside interview, I was asked about several of my faculty as well as my experience as a prelim and the circumstances for not matching on my first application. My interview with my current program consisted more of how I thought I was performing, if I had any complaints or problems working with the other residents, and how I felt I fit in the program.
After that, it was several more months of hard work, continuing every day as though I was interviewing for my future job. March grew closer every day and all I could think about was match day and that email I would get from the NRMP. It finally came, and I had matched. As luck would have it, I was on the trauma service that month, at a level one trauma center. So match day came, the locations of match positions were emailed out, and I was in the thick the trauma bay, running to radiology to find out what the injuries were for several trauma patients who had just been seen. I saw that I had multiple missed messages and group texts from my fellow residents, all congratulating me on matching with our program. A composite had been sent out when the locations were revealed and I had missed it because I was doing exactly what I had done every day since July 1st. The first person I told was a radiology resident. I barely knew him, but I was bursting. I called my husband and my parents. I responded to messages. And that night, I finally got to experience a match day celebration.
One of the nice things about being a prelim at this program was discovering which faculty had also gone down this track, finding that this wasn’t as uncommon as I initially thought. Our assistant program director had been a prelim. One of our bariatric surgeons had been a prelim, and he does some of the most complex re-operations I’ve seen. One of the vascular fellows also confided to me that he had been a prelim. My research adviser recently informed me that one of the most influential publishers in transplant was a prelim. There were so many people who shared this struggle, the constant insecurity and fear of the unknown, and were willing to divulge those experiences and let me know that being a prelim is not your career’s death sentence.
So for those of you out there who are anxiously awaiting match day, I want you to know that it’s ok to be disappointed if you don’t match – devastated, even. But remember that you are not the first person who hasn’t matched, nor will you be the last. Pick yourself up, swallow your pride, talk to your mentors and administrative staff, and SOAP, scramble. Let the world know that you love surgery with all of your heart and you can’t imagine doing anything else for the rest of your life. Somewhere, there may be a program that sees something in you and gives you a chance. When that happens, don’t give them any excuse to let you leave. Show them why they took a chance on you and prove them right for having done so.