Ninety Alpert Medical School fourth-year students opened letters containing “the culmination of years of hard work” the day before spring break, in a shower of giant red and white balloons, said Katrina Chu MD’14.
On Match Day, held this year on March 21, medical students nationwide discover to which residency programs and specialties they will devote the next three to seven years of their lives.
“Brown’s students placed into some of the most prestigious residencies in the country,” said Alexandra Morang, director of medical student affairs and head of the residency advising program. “We are right there with our peer institutions, even though we are a really young medical school.”
According to students’ self-reported data, 90 percent were placed into one of their top three choices, Morang said. This percentage has remained fairly consistent throughout recent years, she added.
Eight students will remain in Rhode Island at hospitals affiliated with the Med School, while more than 20 others will complete their residencies elsewhere in New England, according to the Med School’s website. Eight will call San Francisco their home.
Libby Flores MD’14 decided to stay in Providence because Brown’s OB/GYN program is one of the strongest in the country, she said.
“When you interview at other hospitals and they mention Brown’s faculty, it’s like they are talking about rock stars,” she said.
Flores can bypass the apartment-hunting scramble and the difficulties of adjusting to a new home that many of her classmates face: Next year, she will live with her partner, who works at the Rhode Island School of Design.
Internal medicine, pediatrics and family medicine are often the most popular fields for students, but “lifestyle specialties,” such as dermatology, provide flexibility and higher salaries and are gaining popularity nationwide, Morang said.
Thirty-eight students at Brown were offered primary care residency positions, according to the Med School’s website. This number has also remained fairly consistent over the past few years, Morang said.
The Med School is supportive of primary care, despite the field’s lower pay and perceived lower prestige, and will “put its money where its mouth is” in 2015 when it offers an integrated primary care and public health curriculum, Flores said.
An atypical application
The National Resident Matching Program is very different from other job application processes. Students are placed in a residency using a Nobel Prize-winning algorithm that takes students’ and hospitals’ preferences into account. The placement is a contract.
“If you were to back out, it would go on your record,” Flores said, which would hurt a student’s chance of getting placed into a residency in the future. “It’s tough — at the last minute, some people realize they really don’t want to go.”
Students with strong academic records in fields like pediatrics often apply to about 12 or 15 residencies, Morang said, but those in more competitive specialties like dermatology or plastic surgery can sometimes apply to 50 or 70.
Interviews are conducted in person at prospective hospitals and can make or break an application, said Jenna Lester MD’14.
Along the “interview trail” this year, some students got stranded in “odd places” due to the flight delays and cancellations that come with winter weather, she said.
“I heard someone took over 30 plane flights, and that was before the interviewing season was over,” Lester said. There’s a fear among students that “if I cancel this interview, what if I don’t get matched?”
In smaller specialties, scheduling interviews can be especially difficult because hospitals don’t coordinate with each other and interview times often overlap, Chu said.
Peculiar interview questions keep students on their toes, students said. Multiple recalled being asked, “If you could be any kind of fruit, what would you be and why?”
“They want to see your thought process and how you present yourself,” Chu said.
Throughout the application process, students base their preferences not only on the strength and rigor of prospective programs, but on the location and social climate, said Heather Jones MD’14. On interview days, students often have lunch with a hospital’s residents to get a sense of whether they fit in.
Broken bones and budgets
Several hundred medical students who entered the National Resident Matching Program this year were not placed into residencies, according to a statement released by Darrell Kirch, president and CEO of the Association of American Medical Colleges, a nonprofit organization that represents medical schools in the United States and Canada.
“There are more students graduating from medical school, but the number of residency spots hasn’t changed” over time, Morang said. “It’s getting more competitive every year.”
Specialty programs have especially high levels of competition. At some hospitals, students may be fighting for a plastic surgery program with only three available spots.
The AAMC is concerned that federal budget cuts to teaching hospitals make expansion of residency training programs “highly unlikely,” according to the statement. As a result, some programs may not even generate enough clinical revenue to stay afloat.
Due to the shortage in residency spots for medical school graduates, there will not be enough doctors trained to combat the nation’s physician shortage, which is expected to increase to 90,000 doctors by 2020, according to the statement.
With overwhelming debt from student loans, many Brown students said not having a job after graduation would be devastating.
“It has been scary, even at Brown,” Jones said.
The cost of the matching application process itself is another load students carry. The interviewing process can cost thousands of dollars — the application fees, airplane flights, hotel stays, car rentals and cab fares add up.
Though some hospitals cover the costs of boarding and travel, many students foot the bill or take out even more loans, Lester said.
The Med School’s financial aid director keeps the high costs of the application process in mind when she’s drafting financial aid packages for fourth-year students, Morang said. There are also waivers outside Brown for which students can apply.
Care and counseling
There are 42 specialty advisers and nine Careers in Medicine faculty members who advise academies, learning communities that bring students of different class years together, Morang said. Advisers work extensively with alums, who often let students stay at their homes for free during the interviewing season and offer firsthand perspectives on the hospitals students are applying to.
“I didn’t feel like I walked into an interview unprepared,” Lester said.
Some students have also worked to improve the advising process.
Unlike undergraduate or graduate college admission, there aren’t GPA or test score databases for residency admission, which makes it difficult for students to rank programs or know where they stand in the applicant pool, Jones said.
Rahul Banerjee MD’14 designed a website to solve this problem, providing anonymous advice from students graduating this year about specialties, the interview process and the beginning of med school, Banerjee wrote in an email to The Herald. He added that he does not know if other med schools have developed “a solution as robust as ours.”
The website has already received about 40 responses, Banerjee wrote, adding that he hopes to expand the system so alums can submit responses.
Brown’s personal advising experience and student camaraderie is unheard of at many other institutions, students said.
At other med schools, and even during residencies, “there is a sense of sink or swim, of doing things on your own,” Flores said. “It’s good to be independent,” but distancing oneself from peers and patients is problematic in a hospital setting where camaraderie is necessary for efficiency and success, she added.
Stethoscopes and strawberries
A video of fourth-year Brown students dancing to Pharrell Williams’ “Happy” from rooftops and places all across the globe jazzed up Match Day. Strawberries, sparkling wine and a jazz band enlivened the happy occasion. Friends and family came from out of town for the celebration, which students said is more exciting than graduation.
“It was so surreal,” Jones said. “This is something I’ve wanted since my fourth-grade career project.”
“It didn’t hit me until I found out one of my really good friends matched at the same hospital,” Chu said. “We’ve been living together for a really long time. I teared up a little bit.”
“Every school has a celebration, but everyone does it differently,” Morang said. Brown has “one of the more exuberant celebrations,” while at the same time respecting students’ privacy, she said.
“A lot of schools have each student take the envelope, open it and read the name in front of everyone,” Morang said, which can be uncomfortable if students don’t receive the placement they were hoping for.
After developing close relationships with students, Morang was especially touched by Match Day, she said. But the most emotional time for her occurred a couple days before, when Morang received the match list.
“That precious time of knowing how thrilled they are going to be before they open that envelope and knowing how hard they worked for it, anticipating their joy — that’s really special,” she said.
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