Where You Match Is Only ‘A Step in the Journey’

Jesse Ehrenfeld, MD, still remembers that day 21 years ago.

Getting wheeled back into surgery on a stretcher and preparing to go under anesthesia, Ehrenfeld recalls feeling “so nervous” about matching with a residency program. That is, until someone on the surgical team discovered his pager went off and shared with him the good news.

Relief flooded over him. Ehrenfeld didn’t yet know where he matched — or if he would get his first-choice internship and residency programs — but he knew he was going somewhere as he drifted off into unconsciousness.

“I was able to go to sleep knowing that I had matched,” he said.

Every March, fourth-year medical students await Match Day: An event that will shape the next 3-5 years, and possibly beyond, of their professional and personal lives. This year, Match Day falls on Friday, March 21. Then, tens of thousands of medical students will find out where they will take the next step of their careers.

The National Resident Matching Program (NRMP) administers the program leading up to Match Day. The private, nonprofit group currently supports over 47,srcsrcsrc fourth-year medical student registrants per year. About 92%-95% of US MD seniors get a match, according to NRMP. It uses an algorithm to match medical students and doctor of osteopathic medicine students to open spots in residency programs. The match is also generally binding for the first 45 days of training, according to NRMP. When a student matches and signs the contract, they need to pack up and go. Those circumstances can be stressful.

You never know how these things are going to work out, said Ehrenfeld, who often advises medical students about matching.

“Even the best students have the anxiety of worrying about whether they’re going to get a position and whether they get a position at a place where they want to train,” he said.

Regardless of the Result, It’s a Busy ‘Momentous’ time

After a medical student gets their results on the Friday of Match Week, “it’s a momentous moment with a lot of emotion and a lot of stress and a lot of excitement,” Ehrenfeld said. “Regardless of the outcome — and it doesn’t matter if you get your first choice, if you get your last choice, or if you don’t match — there’s a lot wrapped up in this day that’s been 4 years for most students coming.”

There’s also a flurry of activity that happens once medical students find out where they’re going, said Ehrenfeld, now a tenured professor of anesthesia at Medical College of Wisconsin, Milwaukee.

After learning of their match status, students now need to transition into the next phase of their career and that includes finding a place to live and getting a medical license.

Yes, there’s a lot to do, but make sure to mark the moment, Ehrenfeld advised. “It’s an achievement and it’s important to celebrate.”

Elyse Cortez, MD, a first-year resident in neurology at University of Texas Health in Houston, did just that after finding out that she and her twin sister both matched to their first-choice institution. The pair had requested a couples’ match at the last minute. They thought it would help them “cope with the stress” of residency if they could stay together, she said. At the same time, they feared they would look “co-dependent” to the decision-makers. Finding out they both matched to UT Health Houston for residency is one of her best memories of medical school. Today, the sisters are in different programs there (Cortez’s sister is in internal medicine), but they live together and help each other “stay unstressed” at work, she said.

For first-year psychiatry resident, Cassandra Balson, MD, “the feeling of matching at your desired program makes all the ugly and hard truths of medical school feel so worth it,” she said in an email. Balson is currently at Medical College of Wisconsin.

What To Do If You Don’t Get Your First Choice

Statistics show that most medical students will get some type of a match but unlike Cortez and Balson, it may not be their first-choice program. The key is to be ready to transition to any of the programs on the rank list, “so regardless of whether it’s your first or second or your ninth choice, in your mind, you can see yourself there,” Ehrenfeld suggested.

Of the US MD seniors who matched, about 48% matched to their first-choice programs in 2src24 and about 74% matched to one of their top three choices, according to NRMP.

A few days after his surgery, Ehrenfeld found out he matched to his first-choice internship and residency programs at Massachusetts General Hospital in Boston. He was thrilled but then overwhelmed, too. “Oh, it’s March now,” he recalled thinking soon after finding out. “I got to move.”

But —there are plenty of people who don’t match to their first-choice program and still must move (and are less than thrilled about it). Ehrenfeld tells students in this circumstance that they’ll still be physicians ultimately, and this is “a step in the journey”.

“Where you match and where you train is obviously exciting and important, but it’s just a part of one’s career,” he said.

Caroline Knoop, MD, went through Match Day in 2src21 and described the process as “nerve wracking but also exciting.” She did a couples’ match with her husband. Her match happened during the COVID-19 pandemic, so everything was virtual including interviews in her chosen specialty of pediatrics. “Going into kind of ranking, it was hard to kind of figure out exactly what I wanted out of a program,” she said.

On Match Day, Knoop was at home in Florida. She found out that she matched with the University of Maryland Children’s Hospital in Baltimore. It was neither she nor her husband’s first choice.

At the time, Knoop felt a mixture of emotions. She didn’t know the city of Baltimore well and had no family and friends there. She reviewed her notes from her original Zoom interview and they were all positive. Today, she is chief resident there and “can’t imagine” being anywhere else for training, she said.

If a medical student gets accepted to a second or third-choice program and they really want something else, in most circumstances, Ehrenfeld advises students to take that position and then consider reapplying to another program later. For one thing, you need a job, he said.

As Knoop did, some students ultimately “fall in love” with what they’re doing, he said. Others go on to change residency programs later, which is not uncommon.

“Not every path to the end of one’s career is a straight line,” Ehrenfeld said.

Didn’t Match at All? Be Proactive

Generally, <1src% of US seniors in medical school don’t match at all, according to the AMA Newswire. Nobody wants to be in the situation. You can’t practice medicine without going through a residency program, however “don’t have a pity party — it’s time to think about next steps,” Ehrenfeld said.

There are options. Students can enter the Supplemental Offer Acceptance Program which offers the opportunity “to try to secure an unfilled residency spot,” Ehrenfeld said. Be proactive, he advises, as the process happens very quickly.

Also, consider seeking out mentorship from your medical school, he suggested. Look for research opportunities to bolster your future chances of securing a residency. There is also the AMA’s FRIEDA database of “constantly updated” accredited residency and fellowship programs that unmatched students can explore. Another option is to take the United States Medical Licensing Examination (USMLE) Step 3 — which graduated medical students generally take near the end or after their first year of residency. Unmatched students can do this to “reassure” a residency program that they are capable of completing the work required, Ehrenfeld said. Another option is to get a job in a clinical setting, such as becoming a “medical scribe” to gain more skills.

Most students don’t match due to: Low scores on USMLE Step 1, they weren’t competitive for their first-choice specialty but would have been for a different specialty or didn’t have enough programs on their Match rank list, Ehrenfeld said. It’s good to aim high but have enough programs on the list to ensure a match, he advised.

“Even if it doesn’t work out in the way that you’re expecting it to on that day, you will be in a place where you can figure out how to make the best of it, and you actually might end up exactly where you’re supposed to be,” said Knoop, the chief resident at Maryland Children’s Hospital.