The Match: Beginning The Burn Out of Young Physicians

October 3, 2016

With the fall of leaves and the drop in temperature, there is a rising level of anxiety as interview season closes in upon senior medical students.

With the fall of leaves and the drop in temperature, there is a rising level of anxiety as interview season closes in upon senior medical students. The senior medical students (by now approaching an average of a quarter million dollars of debt) will have to start off by dropping a hundred bucks give or take to get their transcripts and application in the system, then another $30 for applying to additional programs beyond the bare minimum. For those applying to four to five dozen programs in competitive specialties (the average orthopedic surgery applicant applied to 70 in 2015), the "nominal fee" ends up not being so nominal after all. And that was just the warm-up.

There then is the cost of a dozen plane tickets to travel to interviews, carry-on fees, renting a car, lodging expenses near interview places, etc. Along with the monetary cost, there is the cost of mentally preparing for interviews, loss of sleep traveling, the time standing shoeless in line at the airport, and the toll on emotional wellbeing. Essentially, setting up for the match is draining in all aspects of the word--draining emotionally, physically, and financially.

But that is only the half of it. Then there is the actual Match day, with bottled-up emotions of hope and fear at critical pressure, almost ready to explode depending on the strike of the Match.

I remember seeing actual emotional explosions on match day — both those of joy and disappointment. I will never get the images out of my mind of seeing my friend's wife throw down his match letter in frustration and start crying after finding out they weren’t going to their number one spot. She had a job she liked. They had bought a house. They had friends around. And now, they were going to have to move across the country to a new place. She'd have to find a new job. They'd have to sell their house. She'd have to make a new social network (since digital ones aren't really a substitute, no matter how hard Mark Zuckerberg and the like work to make it so). I wonder how much my friend and his wife's burnout threshold for his career were lowered that day.

I saw other Match-made explosions split young medical couples who didn't put all their eggs in the couples-match-basket, or sent the soon-to-be MD to a neighboring state while her graduate student husband had to stay behind to finish his training, or the smart engineer with a good job searching for ways to follow his wife to her residency city, or the compassionate lawyer give up law to follow her husband.

There is virtually no way around The Match's ring of fire. The "All In Policy" demands all positions be offered through the Match with exceptions only toward those programs designed to funnel students into specific residencies (e.g. rural primary care). Penalties for offering positions outside of the match include an investigation (and I can’t imagine how much paperwork that would entail) and sanctions from participating in the Match the following year. On top of this cost and anxiety, there is a growing percentage of senior medical students that do not get a residency spot despite having adequate qualifications, having just poorly played their cards and getting burned by the Match.

What if the policy was "All-but-one,” so programs could have one spot with a little more flexibility? That way, programs could take satisfactory applicants with extenuating circumstances, on conditions that those applicants work for less, longer, or even for free in order to not coerce their significant other to make difficult decisions, to not force relocation or termination of their spouse's job, to stay near family and friends during the grueling time of residency, etc.? Can you imagine the fiery resentment people with such circumstances might carry through their residency, even if only subconsciously? How could the Match not contribute to burnout in these situations?

If we want to diversify beyond the 1952-free-and-single-male-senior-medical-student model the Match was made for while making a way for socially stable and less burnt-out physicians, we need to rethink and even possibly extinguish the Match the way it stands.