The Match Gods

Match week is possibly the most emotionally exhausting weeks in all of medical school, beating out waiting for board scores, and beating out our first times presenting on family centered rounds. It is a week that we often have to explain multiple times to family and friends who are not in medicine, all the while anxiously awaiting the results of an algorithm that will place us where we will start our careers as physicians.

It all begins in mid-January, when fourth year medical students apply to residency programs via the Electronic Residency Application Service (ERAS). ERAS is a centralized application system which most U.S. residency programs participate in. Next, medical students register for the Match through the National Resident Matching Program (NRMP). Students enter the list of residency programs where they interviewed and they’re considering. Meanwhile, programs are completing the same process with applicants who they have interviewed and are making their own lists. This may be agonizing or easy, but once done, the list must be certified by the deadline of mid-to-late February. Then NRMP’s Match algorithm sorts the list, in order of preference, from both sides and everyone waits for Match Week. (Usually the third week in March).

The process, once explained, is fairly straightforward; applicants rank programs, programs rank applicants, a Sorting Hat magically places new residents in hospitals. The last part is obviously a joke, there is nothing mythical about The Match. And yet, it feels like there is. It feels unknown, because although we, like Harry Potter, have a say in the process, there remains a degree of unpredictability that makes the whole thing seem rather like wizardry. And the resulting emotions can be as equally volatile, from the start. From exultation, to despair, to surprise, to relief, to fear, to confusion.

The Monday of Match Week begins the emotional rollercoaster, on which we have all purchased a ticket ($85 is the registration fee), and on which applicants will find out if they have matched to a program. This could be a day of celebration, or, for some applicants, anguish. In the 2019 match, there were 38,376 active applicants for 35,185 total positions. 79.6% of applicants matched to a first year or PGY-1 position, and 94.9% of PGY-1 positions were filled. Before the results are released, there is always a degree of fear of not matching. It seems impossible, until it happens, and it’s devastating, if it does. No matter how prepared you are, how many programs you ranked, how many times you practiced your interview skills, nothing truly erases this fear. What if it is you?

An email is sent out at 11:00AM EST to all those certified on the match. The subject line, perhaps to inject some humor to the situation reads, “Did I Match?” The effect of this email can feel like the act of a deity – the Match god – incomprehensible, life-altering, incredible. I remember the tears that filled my eyes when I read “Congratulations! You have matched!” But I cannot imagine the horror some students felt upon, instead, getting the message, “We are sorry, you did not match to any position.” There is something crushing about what we perceive as failure in medical school; we don’t feel the pain on behalf of ourselves alone. We feel the full weight of not wanting to disappoint the family and friends who have taken this journey of medicine with us. Even when there is a small voice acknowledging that we did our best, medical students are experts at assuming blame, and it is often hard to believe the words of mentors, family, and friends, that we are, in fact, enough.

For students who matched, the email means waiting until Friday at 12:00PM EST to find out where they have been placed. For students who did not match, it means beginning the SOAP. It is often lamented that there are too many acronyms in medicine, with multiple meanings, and this is one of those. Unlike in presentations, where SOAP means Subjective, Objective, Assessment and Plan, this SOAP, within The Match refers to the Supplemental Offer and Acceptance Program. No one wants to SOAP. It is a process during which students are allowed to apply to available spots at unfilled programs. A list of unfilled spots is made available to applicants and they may designate which programs will receive their applications. Following this, a series of offers are sent out by programs with available spots, which may be accepted, rejected or be left to expire. There are three rounds of offers, after which the SOAP ends.

Some students, not all, match to a position during the SOAP, either in their field of choice, a similar one, or an altogether different path. It is a difficult decision to potentially change the course of your career within a two-hour period after spending, possibly, years with a dream. According to the National Resident Matching Program (also known as The Match), most offers are accepted during the SOAP, with only a small percentage being rejected. It is all in preparation for Friday, Match Day.

Most medical schools in the United States have events surrounding Match Day, from pre-match dinners, to student award ceremonies before noon. It is the culmination of years of hard work, many tears, many victories and many hopes. Some schools have students come up to a stage to read out their placements. I learned this on the interview trail and could not suppress an astonished laugh. As the date drew closer, the match process seemed to take on the shape of an arranged marriage, and announcing potentially shocking news to a crowd seemed like the last thing any medical student would want to do. Yes, certainly there’s a good chance we will match within our top three programs, the data from past match years show that most students do. But it is still a deeply personal moment; even in my profound happiness on the fateful Friday, I felt a little overwhelmed.

I knew, of course, why they did it. Every year, I had waited excitedly for the match list. I had watched, and re-watched, the match videos that each fourth year class makes. I would certainly have gone to an auditorium to see my upperclassmen announce the result of their hard work. These videos inspired me every year – reminding me that there was a light at the end of the tunnel. A light that shined on smiling fourth year faces, soon to be resident physicians. As a fourth year waiting to open my envelope with my parents at my side, I felt neither like smiling nor like an inspiration. I felt the tight knot of anxiety squeeze around my stomach as I fumbled with the envelope. I was trying to read, but realized my tears had blurred my vision. Finally, I focused. I must have screamed. My sister was Face Timing from across the country and I yelled my match into the phone. I couldn’t tell who was crying louder. Northwestern McGaw/Lurie Children’s. My sister had, a few months before, been accepted to and chose to attend the University of Chicago Booth School of Business. It had influenced my decision, knowing that I would be with family during my residency. If I matched there. There had been no absolutes.

We work hard as medical students, to learn, for our patients, to be better everyday. We are tested constantly, asked to demonstrate our knowledge, but also to keep curious. It all seems to rest on what is said on that piece of paper, on that Friday, at 12:00PM EST. It should not be all about that, after all, the series finale doesn’t change the beauty of an excellent show. To the upcoming fourth years, who are now preparing to begin this process: remember to enjoy it, remember some things may not work exactly as planned, remember that you have worked exceptionally hard to be here, remember that you are enough. May the Match gods be ever in your favor.

Photo by William Mueller, from SUNY Upstate Medical University’s 2019 Match Day Celebration.