The Match Experience: Part 1 — The Problems
Written by Andrew Woods
“But wait
If I could shake the crushing weight of expectations
Would that free some room up for joy
Or relaxation, or simple pleasure?
Instead we measure this growing pressure
Keeps growing, keep going
'Cause all we know is
Pressure like a drip, drip, drip that'll never stop, whoa
Pressure that'll tip, tip, tip 'til you just go pop, whoa-oh-oh”
- Surface Pressure, Jessica Darrow, from “Encanto”
I write this feeling like I’ve completed a marathon. This process officially started back in June 2021, but truthfully, it started on my first day of medical school. Everything I have done has been to position myself for the Match process, and after coming to the end, I’ve had some reflections on
Growing Expectations in a Virtual World (Pre-Application/Interview)
The COVID-19 pandemic created a new world for everyone, and medical applicants certainly weren’t excluded from that. The Class of 2021 were the guinea pigs, having their clinical rotations postponed, away rotations eliminated, and interviews moved online. After the Graduate Medical Education (GME) community had some time to reflect, they largely…did the same thing for the Class of 2022. While clinical rotations resumed, for many of us, away rotations were restricted and interviews remained virtual, with some added organization compared to the year earlier. However, because programs had a year to get organized for virtual recruitment, application, and interview season, they were able to arrange things like pre-interview “Meet the Program” events, resident-led “Meet and Greets,” and post-interview “Second Looks.” While programs state that attendance at the events is optional, it is difficult for applicants to believe that a program seeing someone participating doesn’t gain an advantage, even small, over those who cannot attend. This pushes applicants to attend as many information sessions, meet and greets, and second looks as possible, further exacerbating the Zoom fatigue that already plagues students. After looking back over my schedule, I participated in close to 100 different virtual events from August through January, oftentimes with multiple in one night. Before the pandemic, applicants traveled to programs for dinner, their interview, and then headed home. While the virtual environment has allowed more applicants exposure to more programs, it has also increased the overall burden on applicants in a time when stresses are already high.
Lots of Programs, Little Bit of Information (Pre-Application)
We have discussed application fever ad nauseam, so I won’t get into that here. The bigger issue, and one that I believe is fueling application fever, is the lack of specific information available to applicants. The National Resident Matching Program (NRMP) releases information each year about the averages within each specialty, allowing applicants to gauge their competitiveness for the specialty as a whole. However, when evaluating individual programs, the waters become far murkier. While programs will talk about their holistic review process (and I will caveat that some are genuine in that review!), there are plenty of stories of applicants receiving a rejection just hours or days after their application, indicating some form of an internal filter. I can’t blame programs for utilizing them, and I believe they can serve a purpose for navigating through hundreds of applications in a short amount of time. But the idea of an applicant spending money for something that was never an option for them is not a great look for the GME community.
Pressure Like a Drip, Drip, Drip…of not getting Interview Invites (Pre-Interview)
Imagine this scenario: you submit your applications, don’t hear anything for a couple of weeks, and then you hear that the first interviews from a few programs have been offered. Another couple of days go by, and more interview offers are extended from more programs, and you still have nothing. Now a month has gone by, lots of interview offers are out there, and you have just a few, wondering if more will come. Now your top program extends you an interview, but you were participating in your surgical rotation and didn’t see the email for a couple of hours, so you log on to schedule your interview, only to see that all of the spots have been filled.
While I wish that story wasn’t true, it was directly relayed to me by a 2022 PM&R applicant, panicking about whether they had enough interviews while also beating themselves up for not having their phone on ring at all times. One of the biggest flaws in the Match process is the constant trickle of interviews over multiple months, forcing applicants to remain tied to their technological devices, scrambling to schedule interviews as soon as the email comes through, all while balancing their clinical duties as a student. In addition to this, applicants are often left in limbo about their application status, not receiving interviews from programs, but also not rejected or waitlisted. This uncertainty leads applicants to hoard interviews, unsure if the one they just received was their last, ultimately leading them to go on interviews they aren’t entirely interested in just to ensure they have the numbers to make them feel safe. This potentially withholds interviews from applicants that don’t have as many, causing a self-fulfilling cycle of those with lots and those with just a few.
Mixed Signals: The Post-Interview Communication Conundrum (Post-Interview)
Congratulations on reaching this point! So far we have applied to programs, received and completed interviews, and now we are crafting our rank list. The hard part is over, right? Wrong! Applicants now have to evaluate their notes about the programs, their thoughts about their interview impressions, and decide where they feel like the best fit is. In addition to all those stressors and counterbalances, an email comes through that reads: “Dear applicant, we think you would be a great fit for our program. We were very impressed by your interview and believe our program could help you reach your goals.” Well, what does that mean? Did everyone get that email, or am I special? Is it a match violation if I respond to them? If they aren’t my top program, but I still plan to rank them very highly, how does it look if I don’t respond or don’t tell them the right things? Will they rank me lower because I’m not equally effusive for them? I just looked on the Google Sheet and it looks like everyone got an email like that, so am I not special? Maybe they sent that to most applicants but sent something special to their top-ranked students! While these post-interview communications are supposed to be regulated through the American College of Graduate Medical Education (ACGME), programs can skirt these by using less direct language or coded words.
As the recipient of multiple “love letters” this application cycle, I will admit they provided a validating feeling. However, they threw wrenches into already complex thought processes, placing increased stress about my rank list. A real conversation from our dinner table revolved around “this program says they love me and think I would be a great fit, but this other program has been silent. Maybe I should just go where I’m wanted, even if it isn’t the best fit for us.”
This conversation thus far has completely ignored the psychological damage it does to those who do not receive those emails. Every specialty has a Google Sheet that tracks what communications have been received from what programs, which large amounts of students will access (and hyper analyze) throughout the year. While this is an example of applicants hurting themselves and each other, it is fueled by
Concluding Remarks
Yes, I complained a lot here. But I hope that I was able to draw some attention to glaring issues that were experienced or relayed to me throughout the Match process. Overall, I felt like it all went very smoothly compared to my expectations going in. However, I believe there is lots of room for improvement to make this process more applicant friendly, which in turn makes it more program friendly. As a GME community, we should always be striving to be better, which I will detail my ideas for in Part 2, so stay tuned! My goal is to see a system where people feel like the process is fair, like they have some control, and like they are valued future members in medicine.
“I’m the strong one, I’m not nervous
I’m as tough as the crust of the Earth is
I move mountains, I move churches
And I glow ‘cause I know what my worth is”
- Surface Pressure, Jessica Darrow, from “Encanto”
