Residency, fellowship matching: a love-hate relationship

Editor's Note: This month's edition of Resident Insight finds Parag Parekh, MD, MPA, recounting the jitters that are a rite of passage experienced by U.S. medical students as they anticipate match day. Dr. Parekh is pleased that he will be starting his cornea, refractive, and external disease fellowship with Minnesota Eye Consultants in Minneapolis.

My mind, over-stimulated from all this nervous energy, races through the possibilities. Will I get my first choice? Is it possible that I won't get any of my top three choices? How do I not take it personally? How will geography factor in? The cold of Minneapolis? The heat of Miami? The expense of Los Angeles or Philadelphia? The beauty of San Francisco? The convenience of staying in Baltimore?

First, second, or third choice?

My mind flips to the interactions I had with the program directors. When Dr. A said she thought I was a "very strong" candidate, did that mean the program was going to rank me highly? When Dr. B said he looked forward to working with me in the future, did that mean as a fellow, or just as a colleague in corneal and external disease? Did Dr. C, the head of a very prestigious program, seem bored during my interview, or was he just tired from a long day of interviewing?

I give up. It is 2 a.m. I need to sleep. I remind myself that going through the match and enduring the pre-match jitters is better than the alternative-applicants being pressured into taking positions before they've had a chance to consider all their options, something that still continues in medical specialties without a match.

In the next few days and weeks, medical students across the country will experience the same rite of passage. Residency match day is Jan. 18.

The stories are legend from the days before the match existed. The program director tells you that you have an "exploding" offer-the fellowship is yours, but you have only 24 hours to commit to it! But what if you haven't had a chance to interview at all the other programs yet? Do you take the safe bet or gamble that you'll get into a more competitive program?

I can imagine how the exploding offer plays a role in offering some efficiency, though it is terribly unfair to the applicant. Think of the number of phone calls that a program director would have to make as he or she went down the list of applicants, especially in a program that takes four or five fellows.

It is not hard to imagine that this could require 20 or 30 phone calls, just as many returned calls from the applicants, and potentially a negotiation with each phone call (e.g., "I'll take your fellowship for a slightly higher salary and less frequent call."). The amount of time spent could be staggering, and this is minimized to some degree if everyone is required to give a response within a short period. The entire problem is multiplied for residency program directors, because residencies typically are larger than fellowships.