Congratulations, you have matched!!...What’s next??

Congratulations, you have matched!!

If you ask any medical student, they will tell you that receiving these words in their inbox during match week is one of the happiest moments of their lives. They will tell you how extraordinarily significant and meaningful this phrase is, as it not only indicates they will have employment in July, but it signifies that the culmination of their years of hard work, sacrifice and determination have all paid off: 

“I am finally going to be a physician”. 

For anyone who is unfamiliar with this terminology, residency is a period of training a medical graduate will undergo after completing medical school...yes, more schooling! It can range anywhere between 3-7 years, depending on the medical specialty one chooses to practice. With residency comes greater responsibility, as we are now expected to make medical decisions that will impact patient care, for which we are also liable. The “match” is an algorithm which generally favors an applicant's choice. Each applicant will rank the list of programs they were invited to interview with (most preferred to least preferred), and the residency programs will do the same. Once the deadline approaches, the algorithm will “match” each program and applicant together, based on both of their preferences, with the algorithm doing its best to place students at their top choice program. Applicants who do not match will have to undergo the Supplemental Offer and Application Program (SOAP), where they will obtain a list of unfilled positions and apply once again, oftentimes interviewing with multiple programs that same day, in hopes of being placed in a residency program. Unfortunately, unmatched applicants may even be expected to change their preferred specialty, depending on the number of positions available. Or worse yet, may have to reapply the following year. As a medical student who has spent 8+ years going to school, volunteering, sitting in on board exams for hours on end, and acquiring hundreds of thousands of dollars of debt in the process, the news of not matching can be absolutely devastating. Unfortunately, this happens all too often to great applicants who will make wonderful physicians. That being said, we are both blessed to have matched successfully on our first attempt, and better yet, into the specialties of our dreams!  Melissa will discuss her Match experience and moving forward in training.I had a whole host of careers in medicine throughout my life prior to medical school. In my head, I had already been an emergency medicine doctor, a surgeon, a family medicine doctor, an internist, a psychiatrist, and a neurologist. When I actually applied for residency positions, however, I only applied to internal medicine, psychiatry, and combined programs in those two specialties, “med-psych”.The Sunday night before “Match Monday”, the anxiety nausea started. It continued until Monday morning when I got my “Congratulations, you have matched” email. I was grateful that I matched, because despite years of hard-work and sacrifice, a computer algorithm fails A LOT of great applicants.Unlike many of my classmates, I had no idea what I matched into. My rank list was organized by the programs I liked the most, and my combined med-psych programs were high up on the list, but I was unsure how far down my rank list I would fall because I had (and still have) no idea how competitive med-psych programs are. Each one offered only two first-year positions.The time between submitting a rank list and learning where I matched brought up a lot of doubt for me. While virtual interviews were great in many ways, there is still something to be said for being immersed in a potential training environment. It’s easy to control the image of a program for a limited time when the intention is to present the program in a positive light. In real life, not every interaction is “presented”. Interactions occur organically, and that could be positive or negative.From a financial perspective, participating in virtual interviews was a relief, but it left me with worries that these institutions, and people, I would spend the next 3-5 years with might not be what they presented themselves as. Did I make a mistake? Was one of my top programs abusive to their trainees? How would I know? There’s a lot of incentive to conceal toxicity.On Friday, I learned that I did match into one of the med-psych programs! I was elated, because the program I matched into had been very supportive and responsive since the beginning of the application season. Even before I knew I matched there, I reflected on how everyone I interviewed with at that program was able to have a genuine conversation  - and there were MANY interviewers (okay…only six, but it was my last interview and the Zoom fatigue was real).  I felt that I landed right where I was meant to be. The traditional start date for interns (first-year residents), is July 1st. Over the next few months, I will be preparing to move across the country with my partner and my pup. Aside from all the moving logistics, it is difficult to feel like we are starting over again. We will be in a new city. Daniel will have to find a new job. I will be doing a new job. We will have to make new friends. We will need a new doctor and vet. I’ll have to find a new therapist. All these things can be overwhelming to think about. Parts of our Oregon cocoon will remain in Oregon, and other parts will be moving across the country to start-over too. But, in just a short time, I have no doubt that each of us will find a new community to grow with. While I have a lot of fears about this next chapter - including living in an environment where winter shows no mercy - I am finally getting to the part of my training where I actually get to be someone’s doctor and for that, I am grateful.  Ashley will now discuss her experience with the match process as well as her thoughts  surrounding residency training!I had been waiting for match day for almost a decade now, but as the day finally approached, instead of feeling relief and enthused, I found myself riddled with fear: What if I didn’t match? What if nobody wanted me? What if I had to choose a different specialty? I imagine many others were experiencing the same trepidation I was. The match process is already so uncertain, but adding the COVID-19 pandemic to the mix and everyone being forced to adapt to the sudden restrictions and moving everything virtually, it made it that much more uncertain. As a result of the pandemic, there were a higher volume of applicants in the residency pool, making an already daunting process more so….As for me, the odds of matching were against me: my board scores could be better, my passion for mental health had always been prevalent, but I made the decision to pursue well into my 3rd year while others had planned to pursue their entire lives, the number of auditions (these are crucial for a medical student to network and display their skills in their chosen fields) that  I was able to secure were limited due to restricted travel, and the number of interviews I had been offered were less than anticipated given the higher volume of applicants. Despite the odds, the programs I was invited to interview with were all phenomenal, and I was excited for the possibility of joining a family and finally becoming a psychiatrist, a profession I was told was becoming increasingly competitive, and that I should consider a backup specialty. After falling in love with this extraordinarily innovative and collaborative specialty during my 3rd year of medical school, I knew with certainty that this is what I wanted to do, and I refused to be deterred. Upon opening my match email on March 15th, it was confirmed that, against many odds, I had succeeded. I matched into Psychiatry. Not only did I match into Psychiatry, but I matched into a program that had excited me for a very long time, not only for its supportive and camaraderie environment, but it’s new program director had an exciting new vision, one I now get to be a part of.   So, what’s next??? As I start the process of finishing up my last rotation of medical school in Addiction Medicine, my mind is already looking ahead! My orientation date is set to begin June 21, with residency training starting July 1st. Like Melissa, I have already begun the process of preparing to move (mostly packing, house hunting)! Luckily, I am staying somewhat regionally, and even better yet, my fiancé and I will remain close to both of our families! Echoing Melissa, starting over can be extraordinarily difficult and daunting. We spent 4 years creating a home in Oregon, which we will now have to pick up and plant somewhere else. I am fortunate to be moving to a city I have lived in the past, so it will be somewhat familiar (granted, it has been 7 years)! My fiancé will likely remain working in Oregon while I am attending residency, fortunately, long distance is a familiar foe. Moving and starting anew has also become a familiar foe, but this time, it’s different: I am now a resident physician, and I will be training to become a doctor in the community I will now call home. As we prepare to embark upon our greatest adventure yet, I can’t help but have a healthy sense of trepidation. Medical school came with its own challenges and expectations, but residency is an entirely different beast. We are now resident physicians, which means we are responsible for making important decisions that will impact patient care. As a medical student, we are asked to display our clinical knowledge, reasoning and decision making under the close supervision of our attendings, but if we are incorrect, you will always have a more experienced physician present to correct you. In residency, we are supervised, but there are greater expectations of you to have the ability to have good judgment and make quick clinical decisions, particularly in the event of a crisis. I am looking forward to becoming immersed in an environment where I can learn, grow and become the best physician I can be. In addition to the immense pressures that naturally come with increasing responsibility, maintaining my mental and physical wellness will be increasingly important to avoid both physical and emotional burnout. Psychiatry, like many other specialties, can be incredibly emotionally taxing, so it’s always important to ensure you have an outlet. This has always been a priority for me, as I am a firm believer that maintaining mental/physical wellness is key to maintaining the ability to care for yourself, avoid burnout and to provide the utmost quality care to your patients. I will continue to make time for the things I love to do, particularly exercise and hiking, as well as nourishing my support system.While I may have a healthy sense of trepidation, my excitement for the future vastly outweighs any fears! Psychiatry, here I come! I would like to end this blog by taking the opportunity to reflect on the 2020-2021 match cycle: This cycle was unlike any of us has ever seen in the past or will most likely ever see again. From personal experience, it has been incredibly taxing, both emotionally and physically. From auditions being cancelled due to the pandemic, to interviews being moved virtually (limiting interactions where both parties were unable to fully engage with the other for an extended period of time), to interview hoarding (no system was in place to prevent people from accepting more interviews than one would need, leaving many qualified applicants with very few to no interviews this cycle), to the awareness of an increasing amount of medical students each year with no subsequent increase in residency positions to ensure everyone can successfully match into a position.  Our hearts break for the many qualified applicants, who went unmatched this year. My hope is that things can improve for next year, possibly using a unified system for interview invites which might allow for a more equal distribution of interviews, or possibly, increasing the number of residency positions. To everyone that went unmatched this year, we hope you never give up. We see you. We see your hard work and sacrifice. You deserve to be here, doctor.  Co authors: Ashley Maestas, OMS IV & Melissa Mahoney, OMS IV