Adcadet
Storage Freak
As some of you may know, I'm a senior medical student. After 4 years of medical school comes residency, which is from 3-7 years long. Almost everybody does residency these days, except maybe a few who only want to do research, or the moderately insane (the very insane and slightly insane stay in). After residency comes fellowship if you want to subspecialize or just don't like yourself. I am applying to internal medicine (3 years), and am thinking of doing cardiology (3-4 years after my 3 years of internal medicine) after my internal medicine residency, or less likely, pulmonary and critical care (3 years). Unfortunately for me, cardiology is incredibly competitive right now, making my choice of residency very important in the long run as it may affect my ability to enter the subspecialty of my choice.
The story goes that a long time ago, residency programs/hospitals would start to bug medical students well before their senior year to sign a contract to do their residency with them. The competition for cheap labor....er, I mean residents... got so bad that at one point second year students were being pressured to sign contracts before they even knew what specialty they wanted to go into, and were told that if they don't sign a contract with the hospital now, they would never get the chance again. This situation sucked. But so did residency back then, when you were literally a "resident" of the hospital, needed permission to leave the premises, and were basically on duty 24/7.
Eventually students got fed up with this pressure to commit early, and hospitals got tired of having to compete with each other so they all decided to make some rules. The rules didn't really work at first, because they were voluntary and not everybody would follow them (shocker!). A few years later, to make life more fair, and a little less stressful for medical students, the National Residency Matching Program was created, and the rules were actually enforced. With this system, all senior medical students can apply to programs for an interview, go interview at however many places they wish, and on a certain date submit a Rank Order List of places they want to go. Programs review applications, decide who they might like to have and interview them, and then they submit their Rank Order List of people they want. The deadline for the ROL's for applicants and programs is the same: this year it's February 21st at 9 PM Eastern Time. Some time after that, a computer matches them up. The program used to give preference to programs (if "1/2" means a program is an applicant's first choice but the applicant is the program's second choice, then with the old program a 2/1 tentative match was favored over 1/2 tentative match, but that's since been switched).
According to th NRMP, this is how applicants are supposed to rank programs to get the best match possible:
1. Applicants are advised to include on their rank order lists only those programs that represent their true preferences.
2.Programs should be ranked in sequence, according to the applicant's true preferences.
3. Factors to consider in determining the number of programs to rank include the competitiveness of the specialty, the competition for the specific programs being ranked, and the applicant's qualifications. In most instances, the issue is not the actual number of programs on the rank order list, but whether to add one or more additional programs to the list in order to reduce the likelihood of being unmatched.
4.Applicants are advised to rank all of the programs deemed acceptable, i.e., programs where they would be happy to undertake residency training. Conversely, if an applicant finds certain programs unacceptable and is not interested in accepting offers from those programs, the program(s) should not be included on the applicant's rank order list.
The match tends to work very well: they say that something like 85% of all people get one of their first 3 choices. Students are free to rank programs in secret and without any undue pressure, since your ROL is never revealed. This year Match Day, the day at which it is revealed where people have matched, is March 15th, at 1 pm Eastern Time.
Matches are legally binding, which makes this whole process work. So whatever order I have at 9 pm tomorrow is what my Rank Order List will be, and there will be no going back. At 9 pm tomorrow, my fate for the next 3+ years will be made. So I have obviously put a lot of work into figuring out which residencies I prefer. I applied to 18, and interviewed at 8. Of those 8, I would be pretty happy at about 5. The bottom 3 I wouldn't be so happy at, but it's better than the alternative: not matching and having to "scramble" for the unmatched spots. I will not describe that process, because from first hand accounts, it sounds worse than hell. Even thinking about it makes me nervous. Luckily, the chances of me not matching are very small. Not because I'm some sort of super medical student, but because for my specialty, internal medicine, there are more slots than US Seniors. Of course, some of the places on my list are incredibly competitive, but I've listed a number of places so statistically I'll match.
There's a little more to the story here, but for now I'll leave that out. I'll revisit it later.
So, I'm pretty sure about my ROL order, but the whole process is a little nerve wracking at times. It's hard to describe how important Medicine is to me without sounding like a conceited jerk, so I'll just skip that part. But suffice it to day, my residency is a crucial part of the rest of my professional, and personal life, and I'm relying on a computer for this, which is why I'm wondering "how much faith do I have in computers?" I suppose I trust in computers every day without thinking about it. I've taken a graduate exam, a pre-med exam, and three licensing exams that used computers, and wasn't ever too worried about it spitting out my results accurately. I've flown to many interviews, which relied on airplane and air traffic control computers. I've put people into machines that have the potential to zap them with lethal doses of radiation and didn't worry about it. I've hooked people up to machines that time the beating of their heart or breathed for them and wasn't concerned. That was truly life or death: my current concern is just 3 years of my life, not my actual life.
I remember hearing that the computers that run the NRMP match take about 20 minutes to run the actual code, but then they spend 2 weeks running different, but mathematically identical code to verify the results. I guess they don't want to be screwed by a few random electrons getting in the way. (Lord I hope they don't run this thing on overclocked hardware.) But I suppose human error is much more likely to cause problems. Last year one not too competitive anesthesiology residency paid for airline flights and hotel stays for all of their interviewees (few programs will shoulder any cost other than a dinner the night before to allow applicants to meet current residents). Anesthesiology is a bit different because you can match to it in your first year out of med school, or after your second; either way, you need to do a "transitional" year first and some programs have it integrated or let you do it elsewhere. Some administrator in this particular anesthesiology program made the grave mistake of ranking everybody who was applying for a first year spot in a second year spot, and everybody who applied for a second year spot in a first year spots: nobody matched, nor could have matched, at that program. And in the two weeks of checking the match results, nobody saw or wondered why this program matched absolutely zero of its spots. Not only did this screw over that particular residency and the students who wanted to go there, but it had a trickle effect, because people who wanted to go to that particular program were now taking spots at other programs. And nobody could do a thing since it was all governed by a legally binding contract. So I've now checked my match list four times, making sure that the programs listed were indeed the ones I interviewed at, checking the program codes backwards and forwards to make sure I don't get tripped up between like-sounding programs (like Washington University and University of Washington...big difference between Seattle and St. Louis), and I've had my wife go over the list and make sure it resembles what we've discussed.
So, where might I end up? Well, assuming I match, it could be at:
- The University of Minnesota, my home program
- Hennepin County Medical Center, the Minneapolis county hospital
- Abbott Northwestern, a private hospital in Minneapolis
- The Mayo Clinic in Rochester, MN, where I spent a month on a rotation
- Washington University in St. Louis
- Yale University in New Haven, CT
- Beth Israel Deaconess Medical Center, one of the Harvard programs in Boston
- University of Washington in Seattle
So, where do I want to go? Since I'm not careful at all about disguising my identity I'd prefer not to say for now. My rank order list has been submitted and certified, so as long as I don't touch it, as of tomorrow at 9 pm, it isn't up to me anyway!
So, how much do I trust computers?
The story goes that a long time ago, residency programs/hospitals would start to bug medical students well before their senior year to sign a contract to do their residency with them. The competition for cheap labor....er, I mean residents... got so bad that at one point second year students were being pressured to sign contracts before they even knew what specialty they wanted to go into, and were told that if they don't sign a contract with the hospital now, they would never get the chance again. This situation sucked. But so did residency back then, when you were literally a "resident" of the hospital, needed permission to leave the premises, and were basically on duty 24/7.
Eventually students got fed up with this pressure to commit early, and hospitals got tired of having to compete with each other so they all decided to make some rules. The rules didn't really work at first, because they were voluntary and not everybody would follow them (shocker!). A few years later, to make life more fair, and a little less stressful for medical students, the National Residency Matching Program was created, and the rules were actually enforced. With this system, all senior medical students can apply to programs for an interview, go interview at however many places they wish, and on a certain date submit a Rank Order List of places they want to go. Programs review applications, decide who they might like to have and interview them, and then they submit their Rank Order List of people they want. The deadline for the ROL's for applicants and programs is the same: this year it's February 21st at 9 PM Eastern Time. Some time after that, a computer matches them up. The program used to give preference to programs (if "1/2" means a program is an applicant's first choice but the applicant is the program's second choice, then with the old program a 2/1 tentative match was favored over 1/2 tentative match, but that's since been switched).
According to th NRMP, this is how applicants are supposed to rank programs to get the best match possible:
1. Applicants are advised to include on their rank order lists only those programs that represent their true preferences.
2.Programs should be ranked in sequence, according to the applicant's true preferences.
3. Factors to consider in determining the number of programs to rank include the competitiveness of the specialty, the competition for the specific programs being ranked, and the applicant's qualifications. In most instances, the issue is not the actual number of programs on the rank order list, but whether to add one or more additional programs to the list in order to reduce the likelihood of being unmatched.
4.Applicants are advised to rank all of the programs deemed acceptable, i.e., programs where they would be happy to undertake residency training. Conversely, if an applicant finds certain programs unacceptable and is not interested in accepting offers from those programs, the program(s) should not be included on the applicant's rank order list.
The match tends to work very well: they say that something like 85% of all people get one of their first 3 choices. Students are free to rank programs in secret and without any undue pressure, since your ROL is never revealed. This year Match Day, the day at which it is revealed where people have matched, is March 15th, at 1 pm Eastern Time.
Matches are legally binding, which makes this whole process work. So whatever order I have at 9 pm tomorrow is what my Rank Order List will be, and there will be no going back. At 9 pm tomorrow, my fate for the next 3+ years will be made. So I have obviously put a lot of work into figuring out which residencies I prefer. I applied to 18, and interviewed at 8. Of those 8, I would be pretty happy at about 5. The bottom 3 I wouldn't be so happy at, but it's better than the alternative: not matching and having to "scramble" for the unmatched spots. I will not describe that process, because from first hand accounts, it sounds worse than hell. Even thinking about it makes me nervous. Luckily, the chances of me not matching are very small. Not because I'm some sort of super medical student, but because for my specialty, internal medicine, there are more slots than US Seniors. Of course, some of the places on my list are incredibly competitive, but I've listed a number of places so statistically I'll match.
There's a little more to the story here, but for now I'll leave that out. I'll revisit it later.
So, I'm pretty sure about my ROL order, but the whole process is a little nerve wracking at times. It's hard to describe how important Medicine is to me without sounding like a conceited jerk, so I'll just skip that part. But suffice it to day, my residency is a crucial part of the rest of my professional, and personal life, and I'm relying on a computer for this, which is why I'm wondering "how much faith do I have in computers?" I suppose I trust in computers every day without thinking about it. I've taken a graduate exam, a pre-med exam, and three licensing exams that used computers, and wasn't ever too worried about it spitting out my results accurately. I've flown to many interviews, which relied on airplane and air traffic control computers. I've put people into machines that have the potential to zap them with lethal doses of radiation and didn't worry about it. I've hooked people up to machines that time the beating of their heart or breathed for them and wasn't concerned. That was truly life or death: my current concern is just 3 years of my life, not my actual life.
I remember hearing that the computers that run the NRMP match take about 20 minutes to run the actual code, but then they spend 2 weeks running different, but mathematically identical code to verify the results. I guess they don't want to be screwed by a few random electrons getting in the way. (Lord I hope they don't run this thing on overclocked hardware.) But I suppose human error is much more likely to cause problems. Last year one not too competitive anesthesiology residency paid for airline flights and hotel stays for all of their interviewees (few programs will shoulder any cost other than a dinner the night before to allow applicants to meet current residents). Anesthesiology is a bit different because you can match to it in your first year out of med school, or after your second; either way, you need to do a "transitional" year first and some programs have it integrated or let you do it elsewhere. Some administrator in this particular anesthesiology program made the grave mistake of ranking everybody who was applying for a first year spot in a second year spot, and everybody who applied for a second year spot in a first year spots: nobody matched, nor could have matched, at that program. And in the two weeks of checking the match results, nobody saw or wondered why this program matched absolutely zero of its spots. Not only did this screw over that particular residency and the students who wanted to go there, but it had a trickle effect, because people who wanted to go to that particular program were now taking spots at other programs. And nobody could do a thing since it was all governed by a legally binding contract. So I've now checked my match list four times, making sure that the programs listed were indeed the ones I interviewed at, checking the program codes backwards and forwards to make sure I don't get tripped up between like-sounding programs (like Washington University and University of Washington...big difference between Seattle and St. Louis), and I've had my wife go over the list and make sure it resembles what we've discussed.
So, where might I end up? Well, assuming I match, it could be at:
- The University of Minnesota, my home program
- Hennepin County Medical Center, the Minneapolis county hospital
- Abbott Northwestern, a private hospital in Minneapolis
- The Mayo Clinic in Rochester, MN, where I spent a month on a rotation
- Washington University in St. Louis
- Yale University in New Haven, CT
- Beth Israel Deaconess Medical Center, one of the Harvard programs in Boston
- University of Washington in Seattle
So, where do I want to go? Since I'm not careful at all about disguising my identity I'd prefer not to say for now. My rank order list has been submitted and certified, so as long as I don't touch it, as of tomorrow at 9 pm, it isn't up to me anyway!
So, how much do I trust computers?
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