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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 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) 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.


Good luck, Aaron! Definitely appreciate the tips for navigating interviews and the match! Good luck to all 4th years as they navigate their future Career In Medicine. Jerry

Posted by Jerry P Abraham, MPH on January 28, 2013 at 11:29 PM CST #

Hi Aaron, Thanks for sharing your story. I am a first year and I am very interested in possibly applying to a combined FM/Psych program - I'm interested in family medicine, ob/gyn, and psych, and desire to integrate mental health and physical health-which aren't really separate to begin with! Do you have any advice? What made you decide to go that route? Any thoughts on the combined programs vs the FM only programs you interviewed with - how is applying for a combined match different? Is it harder to compare with fewer (and possibly more unique) programs? Also, how did you get involved with regional/national FM groups? I'm in my school's FMIG group but am interested in learning more. Thanks! Kelsey

Posted by Kelsey Murray on February 02, 2013 at 09:04 PM CST #

Thanks for your questions Kelsey! Maternal health is a great niche in combined training, an area which is generating a lot of interest in the combined community. Now to your questions. When I was interviewing at programs, a residency director told me that the three areas he sees combined graduates practicing are in academics, rural locations, patients with dual diagnoses, and care for homeless or incarcerated populations. And I agree. A combined resident told me that she thinks of herself as a “family physician on steroids” and upon graduation, will treat the primary care needs of patients who are mentally ill. When I was looking at programs, combined family medicine and psychiatry residency was attractive because after graduating, I would be prepared to not only work in underserved areas, but also tailor my practice to patients who have been societally stigmatized. Applying to the Match in combined training is the same process for family medicine; the main difference is that the spots are much fewer. There are 5 programs with 10 spots per year. Also, comparing the combined programs is similar to comparing categorical family medicine programs; there are unique attributes to each that appeal to the applicant. Just like in categorical family medicine where applicants are faced with questions like opposed vs. unopposed, urban vs. rural, community vs. academic medical center, three years vs. four. I encourage you to spend time during your fourth year at the different combined programs and see how you “mesh” with the residents. And definitely reach out to your mentors! As far as state and national involvement, the department chair at my medical school suggested that I attend National Conference and consider running for a position. The summer after my first year of medical school, I ran for the Student Delegate to the Congress of Delegates and I lost. But, I was selected to represent the Midwest as a Family Medicine Interest Group Regional Coordinator and loved the experience. I was able to communicate with enthusiastic FMIG leaders and learn more about the “inner workings” of the Academy. After that, I was hooked! I was elected (finally!) as the Student Delegate to the Congress of Delegates and then as the Student Member of the AAFP Board. So, I encourage you to become involved. I have met amazing family physicians who are see patients and effect change on the local, state and national level. You will have the time of your life. Hope this helps! Aaron

Posted by Aaron Meyer on February 04, 2013 at 01:34 PM CST #

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