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Monday Jan 28, 2013

Preparing for Match Grueling but Rewarding

Sadly for us mere mortals here in the real world, there is no Harry Potter-style sorting hat to magically place every medical school graduate into the residency program that would be an ideal fit for both the resident and the program.

Instead, we have the Match.

So last week, I, along with more than 16,000 other fourth-year med students, started ranking my list of potential destinations. The questions we face seem endless, but here are a few of the big ones:

  • What specialty will I select? (OK, I know the answer to that one, but some of my peers may still be struggling with it.)
  • What region of the country will I live in? (And how is the weather there?)
  • Who will train us and mentor us once we get there?
  • What job options will I have when I'm through?

We have until Feb. 20(www.nrmp.org) to finalize our lists, and then the system starts churning out potential iterations before finally selecting the one with the most successful number of matches on March 15.

In the end, it's an algorithm -- not a hat -- that will determine how we are dispersed across the country. So it's up to the applicant to do as much homework -- or road work -- as possible before making those rankings. The average medical student interviews with 14 residency programs.

I spent the entire fall on the road, including a four-week rotation on the psychosis floor at Western Psychiatric Institute and Clinic in Pittsburgh and another at St. Vincent de Paul's Family Health Center, a medical clinic for the homeless in San Diego. (Here I am spending a day with residents from that center and its mobile medical clinic.)

In addition to those "auditions," I had 13 interviews in places such as Anchorage, Cincinnati, Denver and Seattle.

I want to work with homeless populations with coexisting physical and mental illness, so I interviewed with four of the five combined family medicine and psychiatry programs in the country. Each of these combined programs offers only two spots, and they each interview nearly two dozen candidates. No pressure.

And on top of that, I have primary care policy and advocacy interests. Sorting out how these family medicine and psychiatry programs compare to categorical family medicine and combined family medicine/preventive medicine programs was a challenge.

But it has been a great experience. Some of my interviews were spread over two days. That gave me time to feel out the programs, meet the residents, faculty and staff. It also gave me time to think about some more important questions, such as "Do I fit in?" and "Does this program fit me?"

That's really what it comes down to. My advice to younger medical students is to spend as much time as you can with residents outside the interview setting. Can you see yourself working and learning alongside these people?

Take time to evaluate where you belong. Reconnect with your mentors when you return to school and analyze what you saw. Who and what do you hope to be, and which program gives you the best chance to reach those goals?

Comparing residency programs isn't like comparing apples to apples. It's more like comparing apples to oranges AND bananas. There are so many innovations and training opportunities, it is an interesting time to pick your ideal residency program.

For example, a combined family medicine and psychiatry residency program I visited had its continuity clinic in a homeless shelter.

A P4 (Preparing the Personal Physician for Practice(www.transformed.com)) family medicine residency provided time for interns to learn necessary skills and bond during month-long "chautauquas" and allowed second- and third-year residents a half a day a week to focus on their areas of interest.

Another P4 program, which has a combined family medicine/preventive medicine residency, had a focus on health policy and practice management, and some graduates move on to become medical directors at federally qualified health centers while others are involved in state and federal policy.

It was energizing to see innovative family medicine residency departments as well as so many impressive applicants excited to make a difference for patients and our healthcare system.

What other advice do I have for students who will go through this process next year and beyond? Enjoy it. Plan in extra time, if possible, and experience the cities you visit.

There were only four hours of daylight when I was visiting Alaska's Family Medicine Residency, but I managed to cram in some cross country skiing and a dog mushing excursion.

I was towed out of a snow bank by a farmer with a tractor while leaving Iowa City. (I couldn't pass up buying cheese curds in Kalona the day after a blizzard.)

I went sight-seeing in San Diego, including a trip to the Cabrillo National Monument (pictured here). I also stumbled upon -- completely by accident, I swear -- a game of nude beach volleyball.

You never know what you might find if you don't get out and look. Here's hoping you find what you're looking for in the Match.

Aaron Meyer is the student member of the AAFP Board of Directors.

Posted at 04:01PM Jan 28, 2013 by Aaron Meyer

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