Texas near saturation point on residency programs
Disregard any screams coming from fourth-year medical students this week; itÂ’s probably the culmination of their excitement and anxiety about where they will be spending the next several years of their life finishing their medical learning.
On March 16, M.D. students and some D.O. students will be finding out whether they were matched to a residency program where they will finish training after graduation from medical school. On March 19, the students will find out where they will go and exactly which residency program they will be a part of.
“Match Day” may be the biggest day in a medical student’s career, and it’s at least on-par with graduation day as the confirmation that the student is close to becoming a practicing physician. Residencies are available in various specialties all across the country (and internationally) and students participate in a lengthy application and interview process before being matched by a national organization.
The National Resident Matching Program oversees the matching process for M.D. students and some D.O. students who apply to dually-accredited residency programs, and other D.O. students are matched through the American Osteopathic Association Intern/Resident Registration Program, which announces matches in February. In 2008 there were nearly 1,500 Texas residency spots available just through the NRMP, and this yearÂ’s local classes will be dispersed across the state and the nation to fulfill this essential part of their medical education.
The match
“A medical student who tells you it’s not scary is fooling you,” said M.L. Budd, director of clinical education for Fort Worth’s Texas College of Osteopathic Medicine.
That scariness comes from the way matches are calculated. Even though students apply and interview at residency programs, they do not make the final decision about where they will serve the next several years. Instead, after visiting programs for interviews, they make a listing of the programs in order of preference.
Each residency program makes its own list, ranking all of the students it interviewed in the order of which it would
most like to have. The rank-order lists of applicants and programs are then fed into a giant algorithm that matches one resident to each slot, and if a program is listed on a studentÂ’s list, then thereÂ’s a chance the student could end up there.
A student can apply to different types of residencies — for example, he or she can interview pediatric programs and emergency medicine programs — but if both types of programs end up on the ranking list, then the student could end up getting assigned a specialty, Budd said.
“If for whatever reason I’m still undecided, I’m going to let the electronic gods decide for me,” he said. “I’m going to step back.”
And if you get matched to a place that youÂ’re not entirely enthusiastic about, tough luck. Applicants agree to serve their matched residency or risk not being able to participate in the next yearÂ’s match if they want to try again, he said
“You don’t get to go, ‘Well, geez, I just don’t want to go where I got matched,’” he said.
Highly competitive
Finding a residency has become more competitive over the years because more students are graduating from medical schools but the number of resident spots in various programs hasnÂ’t increased at the same rate.
The JPS Health network has 150 resident spots open to students through the NRMP match in programs such as family medicine, obstetrics/gynecology, psychiatry, geriatric medicine and a transitional year, which lets residents do one year of residency before moving on to a specialty such as radiology.
Dr. Josephine Fowler, vice president of academic affairs and chief academic officer for JPS, said while applications vary by program, there are a high number of applications per slot.
“Usually on the average it’s about 10 applications per slot available,” she said.
The hospital system looks for people who aligned with the mission of providing care to the most needy in the community, Fowler said, and there are tentative plans to expand the psychiatry program and add a child psychiatry residency program in the next few years.
“It’s very true that especially in our state we don’t have as many slots as we have the number of students graduating,” she said.
However, adding residency spots means analyzing the cost of the program, which must meet nationwide standards and have faculty and other staff support, and its benefit to the surrounding community.
According to statistics from the NRMP, Texas has an average 88.8 percent rate of filling resident spots. The spots are open to students from within and outside the state, and the most in-demand spots — in areas like anesthesiology, dermatology, emergency medicine, family and internal medicine, obstetrics/gynecology, orthopedic surgery, plastic surgery, oncologic and diagnostic radiology — are usually filled every year.
This presents a problem for Texas students who want to stay in the state to complete a residency, said Dr. Don Peska, associate dean for educational programs at TCOM.
“We are near saturation point,” he said.
The scramble
Perhaps the most dreaded match outcome is that there isn’t a match. If a student for whatever reason isn’t matched to a program on their list, then they become part of a frantic few days known as “the scramble.”
The scramble is the days between knowing that a student matched and finding out where the match is. If a student is notified that there was no match, then they meet with advisers to assess which programs to apply to. This year, March 17 will mark the date when a list of remaining open residency spots is sent out to schools, which will help students send out hasty applications over the next few days.
“It has a lot of angst,” Budd said. “We try to put a positive spin on it for the students who are put in that position, but part of the angst is you can’t get the fax machine to work, you can’t get the e-mails to go through, you can’t get someone to answer the phone and time on the clock is running out.”
Budd said the scramble sometimes does offer up interesting or coveted residency spots, but itÂ’s still an ordeal to get those positions during the scramble. Hardly anyone wants to become a part of the scramble, but a student can take steps to avoid being caught up in it, said Dr. Angela Mihalic, associate dean for student affairs at the UT Southwestern Medical School in Dallas.
“I think if you do the process wisely, you can avoid the scramble by applying to lots of different levels of competitiveness in programs,” she said.
The relief
Student Doctor Michael Sprys will find out this week where he will be serving his residency. HeÂ’s part of the graduating class at TCOM, and he went through school on the rural medicine track. He applied to nine programs and interviewed at six, and he said heÂ’d be happy getting matched to any of those six programs.
“The top two programs that I ranked are places that are very, very good programs, and I would hope that I would be ranked high enough by them that I wouldn’t fall down any lower, but I would be fine with any of the programs I ranked,” Sprys said.
Sprys, who will be a D.O., applied to dually-accredited programs that used the NRMP match process. If heÂ’d used the AOAÂ’s match process, he would have already found out where he was matched and wouldnÂ’t be awaiting word on his residency.
“I really regret not doing the AOA match because it would be over, it would be done,” he said.
Many schools have some sort of celebration or ceremony for the students; TCOM will have a celebration once its students who went through the NRMP match will join their classmates who went through the AOA match in having found a residency. At UT Southwestern, students will all go into the mail room at one time to open their boxes and find out where they were matched, Mihalic said.
“It’s quite charged, and we have a little brunch then everyone traipses down to the mailboxes,” she said.
Dr. Scott Smith, a first-year transitional resident at John Peter Smith Hospital, who graduated in 2008 from TCOM, said the waiting between knowing youÂ’re matched and finding out where was the most tense time.
“That part is not fun because it’s like they tease you,” he said. “You’re kind of curious where you’re going but at that point, you’re like, ‘I made it!’”
Finding out that he was going to stay in Fort Worth, where he grew up (Smith is the great-great-great-grandson of Fort Worth mayor John Peter Smith, who donated the land for the hospital in 1877), was exciting, he said.
“It’s just a great feeling because you’re feeling like it’s a big accomplishment. The only thing left is to graduate.”
