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11:00 am
Wed March 14, 2012

Medical Students Cross Fingers For Match Day

For many fourth-year medical students, the future arrives, sealed in an envelope, during the third week of March. On what's known as Match Day, med students find out where they'll spend their residencies. It's a nerve-wracking wait for many that has played out on med school campuses since 1952.

Retired Dr. Sherwin Nuland, who practiced as a surgeon for 30 years, remembers his Match Day. It fell on just the fourth Match Day ever, in 1955. He tells NPR's Neal Conan that the program was confusing in its early years, and students "were advised with a great deal of erroneous information."

Nuland applied to Peter Bent Brigham Hospital in Boston, which is now known as Brigham and Women's, and Philadelphia General. "I ended up unmatched," says Nuland, "and there I was, high and dry."

But when one of his classmates decided to switch his specialty, it left an opening at Yale-New Haven. "And the next thing I knew, I got a call from the chairman of surgery saying almost these exact words: 'Nuland,' he said, 'would you like to join us next year on the surgical service?' "

"Well, at that point," says Nuland, "I would've taken a midwifery internship at Hoboken lying-in or something like that. And I said, 'You bet I would.' And it was ... one of the smartest things I've ever done."

Dr. Atul Gawande of Brigham and Women's Hospital in Boston, who also teaches at Harvard Medical School, met his Match Day in 1995. "It's a strange moment," he remembers. "You stand there in a room with all of your fellow medical students, getting handed a white envelope that tells you what city you're going to live in for the next — for me, seven years of my life in surgical training."

Gawande, who attended Harvard Medical School, matched at Brigham and Women's to the great relief of his pregnant wife, who hoped to continue to see her obstetrician in Boston.

Now, Gawande is on the recruiting side of Match Day, so he understands the process from both sides. "The surgical residents, for example ... will travel to 10, 12 cities to interview," he says. "You kind of size up the joint and then decide, boy, you know, is this somewhere I want to be?"

But it's a tense time for the hospitals, too. "We're all in the selling process," says Gawande, "trying to convince them that, you know, hey, we're all happy people here, and we'll make you great at what you do."

The interviews aren't strictly business, either. "I think the biggest fear that people have is that they're diving into ... a place that they don't want to be," says Gawande. "Probably the most important part of the interviews is that the night before, we make sure that the other residents take them out to a bar somewhere around town and just get them a couple of drinks and let them get to know that they're not just going to be working with a bunch of insane people working 80 hours a week who don't have any kind of life."

But what about doctors who don't match, and who don't get a lucky call like Nuland? They learn their fate a few days early, to spare them opening an empty envelope, and "go into what's called the scramble," explains Gawande.

Formally, the scramble is the Supplemental Offer and Acceptance Program, or SOAP. Unmatched doctors are "put together with hospitals or universities that have not filled their quota," says Nuland, "and they have a period of two hours in which to decide what to reapply to." Later that week, they learn where they've been rematched.

Still, the initial rejection can be a blow to the ego. Unmatched doctors might want to take a page from Nuland's book. "Surgeons, you know, tend to be very narcissistic," he says. "I couldn't imagine [Brigham] would turn me down — impossible to believe. And, of course, they did." But, he says with a laugh, "I never learned from that lesson. I've remained narcissistic ever since."

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

Transcript

NEAL CONAN, HOST:

Friday is a normal day for most of us, but for medical students who graduate this year, it's a kind of hell. It's the day they find out where they will end up as residents - Match Day, a ritual that started in 1952 and changed the course of many lives. We'd like to hear from doctors in the audience to tell us about your Match Day experience. 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our website, at npr.org, click on TALK OF THE NATION.

We're going to hear from two well-known doctor-writers from different generations. Atul Gawande experienced his Match Day in 1995. He's now an associate professor at Harvard Medical School and Harvard School of Public Health. And joins us from Brigham and Women's Hospital in Boston, where he's a practicing surgeon. Dr. Gawande, nice to have you with us.

DR. ATUL GAWANDE: It's great to be here.

CONAN: And Sherwin Nuland, who's a practicing surgeon for 30 years, had his Match Day in 1955. He joins us from Yale University's broadcasting studio in New Haven. Dr. Nuland, nice to have you back on the program.

DR. SHERWIN NULAND: Well, it's good to be here and to have a little reunion with Atul Gawande, as a matter of fact.

(SOUNDBITE OF LAUGHTER)

CONAN: Well, you guys can reminisce in a moment. But, Dr. Gawande, first of all, tell us about your Match Day.

GAWANDE: It's a strange moment. You stand there in a room with all of your fellow medical students, getting handed a white envelope that tells you what city you're going to live in for the next - for me, seven years of my life in surgical training. My wife was pregnant at the time. So, you know, we're sitting there, looking at an envelope that can tell us where we're going to spend what seems like our lives. And I opened the envelope, and it said I was going to be staying right here in Boston, which she appreciated because she had her obstetrician here.

(SOUNDBITE OF LAUGHTER)

CONAN: There are issues like that. Is this like applying for college? Do you apply for certain hospitals, or how does it work?

GAWANDE: You do. You apply to lots of places. You know, the surgical residents, for example, that I see - I'm now on the recruiting side - they will travel to 10, 12 cities to interview. And it's interviews. You arrive for a day. You kind of size up the joint and then decide, boy, you know, is this somewhere I want to be? And we're all in the selling process, trying to convince them that, you know, hey, we're all happy people here, and we'll make you great at what you do.

CONAN: Did you have a safety school?

(SOUNDBITE OF LAUGHTER)

GAWANDE: Well, the - in - you worry that you will not get anywhere. They have been sparing in recent years because they will tell you a couple of days before if you haven't matched anywhere at all. You go into what's called the scramble. And so you...

(SOUNDBITE OF LAUGHTER)

GAWANDE: That way, at least, you're spared that, you know, horrible scene of someone opening an empty envelope.

CONAN: Opening an empty envelope, yeah.

GAWANDE: Exactly.

CONAN: The thin envelope, yeah, in fact. Sherwin Nuland, has it changed a lot since your day?

NULAND: Oh, it's enormously changed. As a matter of fact, it's even changed since Atul's day. This year, they have a new kind of program in which unmatched young people are told, of course, that they're not matched. And they are then put together with hospitals or universities that have not filled their quota. And they have a period of two hours in which to decide what to reapply to. And then later on in the week, they are informed of where the rematch occurred. Interestingly, this program is called the Supplemental Offer and Acceptance Program. The acronym is SOAP, which seems very appropriate for the slippery situation you're in at that time.

CONAN: It makes the NFL Draft sound like, you know, a pretty worry-free comparison.

(SOUNDBITE OF LAUGHTER)

NULAND: But, of course, in my day, I was '55. So we were the third match program, and nobody knew very much about it. And everybody was totally confused about how to advise students, and we were advised with a great deal of erroneous information, only because the plan hadn't really been properly put together yet. And I ended up unmatched.

CONAN: Oh.

NULAND: I applied - naturally, Atul, I applied to the Peter Bent Brigham Hospital, as it was called at that time, because what better place to train in surgery even though they told us that four of the six interns would be from Harvard, and I wasn't from Harvard. So I applied to that, and I applied to the Philadelphia General. I didn't get either one. And there I was high and dry, and one of my classmates who had gotten matched at Yale-New Haven, our own hospital, Dave Nelligan decided that he wanted to be a pathologist.

And the next thing I knew, I got a call from the chairman of surgery saying almost these exact words: Nuland, he said, would you like to join us next year on the surgical service? Well, at that point, I would've taken a midwifery internship at Hoboken lying-in or something like that.

(SOUNDBITE OF LAUGHTER)

NULAND: And I said, you bet I would. And it was the smartest - one of the smartest things I've ever done.

(SOUNDBITE OF LAUGHTER)

CONAN: We have this email from Dr. Ben at Vanderbilt University Medical Center: We have a great Match Day tradition here at Vanderbilt. All fourth-year students gather in our auditorium at 11 a.m. One by one, the dean randomly selects an envelope containing a student's match information. When the student's name is called, he or she comes down and first places a dollar in a fishbowl at the front of the auditorium. He or she can then choose to open the envelope in front of the crowd, publicly declaring often in quite celebratory fashion, his or her residency, chosen specialty and future home.

As a reward for having to wait the longest to find out where he or she matched, the last student called gets to keep all the money in the fishbowl. So tail-end Charlie does OK. As - Dr. Gawande, as you mentioned, you're on the other side of this now, the match process. There are interviews involved, or how much does the school want to know about their future resident?

GAWANDE: Yes. So we're trying to size up these folks, but we also want them to be excited about seeing us. And what you quickly discover is that you are - you can tell them all about the science and the discoveries and the great training they're going to have, but what they want to know is will they fit in. And probably the most important part of the interviews is that the night before, we make sure that the other residents take them out to a bar somewhere around town and just get them a couple of drinks and let them get to know that they're not just going to be working with a bunch of insane people working 80 hours a week who don't have any kind of life.

I think the biggest fear that people have is that they're diving into something - in a place that they don't want to be. And here, we - at least we try to figure out how to make sure that they understand we're friendly.

(SOUNDBITE OF LAUGHTER)

CONAN: We've seen all those medical shows. We know that they don't have a life.

(SOUNDBITE OF LAUGHTER)

CONAN: Dr. Nuland, these people are going to be working very closely with each other. Obviously, they need to know what kind of person they're going to be working with.

NULAND: Well, of course, during the final two years of medical school, I've got a great deal of contact with the kinds of people that are on the internal medical service, for example, on the surgical service, whatever it may be. And there does seem to be a relatively organized personality characteristic for each of these services. And you begin to identify when you're a third or fourth-year student with - actually with members of the house staff, with the interns through residents. And you have a feeling that there's a kind of personality in our specialty. It's kind of locker-room-boy personality that would make you feel comfortable with these people, the kind of teamwork that surgeons have.

So you've got a pretty good idea they may come from different parts of the country. Obviously, the faculty is different, but the mood I think on just about all surgical services is very much the same, and that's true of internal medicine, pediatrics, whatever.

CONAN: Let's see if we get a caller in on the conversation. We'd like to hear your Match Day story, 800-989-8255. Email: talk@npr.org. Patrick's on the line, calling from Boston.

PATRICK: Hello.

CONAN: Hi.

PATRICK: Yes. We were walking away from Match Day in San Antonio, Texas, on the River Walk and had a very successful day and encountered a group of elderly ladies who gushed over us and asked where we had matched and how proud our parents must be of us. And one lady looked us over, head to toe, and said: I wouldn't trust any of you with my big toe. You're all too damn young.

(SOUNDBITE OF LAUGHTER)

PATRICK: So we got a dose of needed humility after being pumped up a bit.

CONAN: I suspect that was both interesting and revelatory at the same time. Did you end up where you wanted to be?

PATRICK: Yes, sir. I ended up in physical medicine and rehabilitation at the University of Kentucky and then went on to a two-year fellowship in pediatric rehabilitation in Ann Arbor.

CONAN: So you've gone on to match quite well throughout your career.

PATRICK: Yes, sir.

CONAN: All right.

PATRICK: Very happy.

CONAN: Thanks very much for the call. Appreciate it.

PATRICK: Thank you. Thank you.

CONAN: Let's see if we go next to - this is Carl(ph). Carl with us from Detroit.

CARL: Hello.

CONAN: Hi. Go ahead.

CARL: Yeah. Well, I just wanted to comment on one thing. I matched back in 1970, and I matched where I wanted to match. I knew I was going to match to Detroit Receiving Hospital at the time because I'd interviewed at city county hospitals around the country and that's the type of surgical residency that I wanted to go into. But the thing that strikes me is how much more is made of match today on the part of the students that are undergoing it as well as the media and guys like you noticing it. I don't think anybody noticed that we matched or paid much attention to it back at that time. At least, it seems like much more is made of it nowadays than it was at that time.

CONAN: Dr. Gawande, is that correct perception?

GAWANDE: Yeah. You know, partly I think it's the reality television world we're in now that we've discovered the kind of dramatic moments in people's lives and their - and this one is an especially dramatic one because you're sort of - your life hangs the next several years of your life and potentially where - how you spend your whole career is driven by this one little moment. And I think it's drawn a lot of attention for that reason.

CONAN: Carl...

NULAND: Well, you know, Neal, I'm going to disagree a little bit perhaps because we work in the Northwest and things are different. I remember our faculty evincing a great deal of pride at the kinds of internships people were getting and also showing a great deal of pride about the young people we had recruited from other schools to be our interns. It was a little bit of a badge that we - that they carried for us.

CONAN: We're talking with Sherwin Nuland, a doctor and writer, also with Atul Gawande, doctor and writer, about Match Day, which is coming up on Friday. You're listening to TALK OF THE NATION from NPR News.

And here's an email from Caitlyn(ph) in Long Meadow, Massachusetts: My husband went through the match in 2002. Our daughter was two. Our son was four days old. We lived in Australia at the time. He woke up at 3 a.m. to find out if and where he had matched. We were thrilled that he matched an hour away from my family. I put him on a plane to Philadelphia five hours later to take his part three English exams. It was a whirlwind day.

And this from Lauren(ph) in Concord, North Carolina: I'm the wife of an intern first-year resident and grateful to be on the other side of Match Day. One year ago today, we matched. I'm a part of this journey, too, and got our top choice at a family medicine residency in Charlotte, North Carolina. What a relief. And, Dr. Gawande, that's a reminder, this involves more than just the graduate student.

GAWANDE: Yeah. The fascinating part of this is this - these are moving whole families. And one of the interesting things that has really changed is that now 55 percent of the schools are female. And there are - is the new advent - it's not so new anymore - of what are called the couples' matches because in medical school, you now have couples who come together and are applying. And then the match doesn't want to split couples apart and put them in separate cities. And so a husband and wife or a pair - you don't even have to be married - can go and apply together. And then it gets even more convoluted because you're trying to negotiate as a couple about where you're going to end up going.

CONAN: And, Dr. Nuland, do some people want to go some place to work with a specific doctor, a great surgeon, for example, or a great pathologist or somebody like that?

NULAND: Oh, there's no question about that. I can verify that from my own case. Atul will remember the great Francis Moore who was the chairman of surgery at the Peter Bent Brigham Hospital. I think any young aspiring surgeon would've given - well, not his left arm because he needs that - probably his cerebral cortex, which he might not need, in order to work with...

(SOUNDBITE OF LAUGHTER)

NULAND: ...in order to work with Franny Moore. Yes, in those days, as we always love to say, those were the days of the giants. And we look to the great men - they were all men at that time - and wanted to work in a residency program where they were to be found, hoping always that they would decide, oh, this is the perfect young man for me to mentor.

CONAN: Let's go next to Henry. Henry with us on the line from Denver.

HENRY: Yes. Well, I didn't match.

CONAN: Really?

HENRY: I put in five hospitals, and they were above my station in life, and they turned me down. And it was a blow to my ego I will never forget.

CONAN: This sounds - if you'll forgive me - that this happened some years ago?

HENRY: 1955, the match was just two years old.

CONAN: And how did you finally end up...

HENRY: Well, I was given a list of places that didn't fill, and I recognized one of them because I was familiar with the hospital in St. Louis, and I called them up right then and there and they said, you're in.

CONAN: You're in.

HENRY: And it was a wonderful experience. It was a wonderful internship, but it was a blow.

CONAN: A blow because on that day, you felt like you had been passed over.

HENRY: And I had been.

CONAN: Yeah. Not good enough. It sounds like you made the best of it though.

HENRY: I've had a wonderful career.

CONAN: And, Dr. Nuland, you seem to have survived as well.

NULAND: Well, to console Henry just a bit, after all these years, a lot of people weren't matching in 1955, and that had to do with the confusion of those early years. And a lot of us had no idea what was really going on. I'm sure the computers may have occasionally goofed things up. I deserved not be matched, but my guess is that Henry, when he so modestly says these were above my station, is cutting himself short. Surgeons, you know, tend to be very narcissistic.

HENRY: I'm (unintelligible).

(SOUNDBITE OF LAUGHTER)

NULAND: I'm sorry. One percent you're not, and that includes Atul Gawande, but the rest of us, you know, the 99, one, it goes everywhere. And I - the reason I applied to the Brigham even though I knew I stood this tiny chance of getting in was, I couldn't imagine that they would turn me down, impossible to believe. And, of course, they did.

(SOUNDBITE OF LAUGHTER)

NULAND: I never learned from that lesson. I've remained narcissistic ever since, which has been a great help in the residency programs.

(SOUNDBITE OF LAUGHTER)

CONAN: Henry, thanks very much for the phone call. And, Dr. Gawande, are your students suffering today as they wait for Friday's announcements?

GAWANDE: No question. There is the run up to the period where the students have to make their rank list. And the amount of rumors flying, don't go to this place, this guy is leaving, gamesmanship that goes on, people calling you from different programs saying if you rank us number one, we'll rank you number one. All of that is in the run up. And then there's after you've put in your list, the computer does its thing, matches things up, and you're fate is cast.

CONAN: Dr. Atul Gawande's latest book is "The Checklist Manifesto: How to Get Things Right." He's an associate professor at Harvard Medical School and School of Public Health, joined us from Brigham and Women's Hospital, as it's now known, in Boston. Thanks very much.

GAWANDE: Thank you.

CONAN: Dr. Sherwin Nuland's latest is "The Art of Aging." He joined us from a studio at Yale University in New Haven. And, Dr. Nuland, as always, thanks very much for being with us.

NULAND: What a pleasure.

CONAN: This is the TALK OF THE NATION from NPR News. I'm Neal Conan in Washington. Transcript provided by NPR, Copyright National Public Radio.