“Have any of you guys been having Match nightmares?” one of my classmates asked in March, a week or so before the 2004 residency placements were announced for 25,000 U.S. medical students (including 107 here in New Haven). Many of us had indeed slept fitfully while waiting to learn where we would be spending the next phase of our training, and for good reason. Yale medical students flocked this year toward the most competitive subspecialties, and with precious few slots in these programs, the process was more than a little nerve-wracking. “It can be a real game of chance,” Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, the associate dean for student affairs, had warned us. “There are no guarantees.”

The late 1990s saw a shift away from subspecialty training in favor of generalist careers. More than half the students in the Yale classes of 2000 and 2002, for example, chose residencies in internal medicine, family practice and pediatrics, and nationally the figure was higher. This year, fewer than 40 percent of Yale students entered these tracks, favoring instead such highly sought-after fields as dermatology and radiology, which also carry higher salaries. One reason seems to be debt, which will average $109,457 for graduating students this year, according to the Association of American Medical Colleges. Another is the desire for a controllable lifestyle with less call and shorter hours. Families have changed, and most physicians will not have a stay-at-home spouse to support a round-the-clock practice. But beyond this, Yale medical students may be predisposed to subspecialize because that is where their curiosity leads them. My classmates are likely to want to become experts in a field and to call something their own.

For nearly every medical student, Match Day is the undeniable climax of four years, a day in which anxiety yields to profound certainty with the rip of an envelope. I approached the third Thurs-day in March on a more even keel than most. Like 16 of my classmates who applied for the early-match specialties (otolaryngology, neurology, neurosurgery, ophthalmology and urology), I had received an early-morning call in January informing me of my match. One moment I was being roused from sleep by a ringing phone; the next I knew for certain where I would be and what I would be doing for the next six years. Many of my friends were on rotations or in class that morning, so my celebration was protracted and intimate. I shared the news with my family and distant friends by phone in the quiet of my room.

March 18, however, was an entirely different matter. After spending the morning discussing professionalism with John S. Hughes, M.D., HS ’76, and other faculty members, we filed into the Marigolds dining area at 11:40 (our itinerary for the day had helpfully noted that from 11:30 to noon, we would experience a time when the “tension mounts”). Family members, significant others and classmates taking a fifth year joined the jittery crowd. At noon the doors to Harkness ballroom opened and my classmates rushed in to open their envelopes. There was a lot of joy and just a little bit of disappointment as people met their match. At around 12:10 the full match list was released and students huddled in groups to marvel at the collective picture, which was on the whole incredibly rosy: an unprecedented 12 students matched in dermatology; a dozen future pediatricians almost uniformly matched at their first choice; six students apiece placed in the competitive fields of orthopaedics, ophthalmology, urology and radiology.

At times it seemed like there were too many people to congratulate. Eliza Auerbach, who will be going to Columbia for pediatrics (her first choice), summed up the sentiments of many of my classmates, noting that she was “happy, but overwhelmed.”

Vernee N. Belcher was ecstatic about staying at Yale for internal medicine/primary care. But even before tearing open that fateful envelope, she reflected that we all had much to be grateful for by having been at Yale Med: “No matter where we match, it’s clear we will all be great doctors.”