Hi Everyone,
Even in our best years, we match just a fraction of our applicants. Which makes sense.
It’s simple math: internal medicine candidates can signal up to 15 programs, and if they choose wisely, they will get nearly that many interviews. So, at rank time, I assume most applicants are choosing between us and 14 other places.
We locked our rank list three weeks ago, but candidates have three more days to decide. By now, they’ve learned all residencies offer similar training: clinics, floors, ICUs, and electives. Wherever they go, they’ll see patients with heart attacks, diabetes, COPD, cirrhosis, substance use, and cancer. At academic programs like ours, they’ll see HLH, huge PEs, ANCA vasculitis, and prosthetic valve endocarditis, as we did last week in the Stepdown Unit. They’ll have research opportunities, learn from renowned faculty, and graduate into top fellowships and jobs.
The considerations are no different now than they were when I made my list in 1988. First, support your loved ones. Heide and I got married during my last year of medical school, and we were ready to leave New York. Heide wanted to be within driving distance of her family on Long Island and to live in a city that offered journalism jobs, which pushed us towards Philadelphia. If you’re matching with a partner, including a non-medical partner, you’re not matching alone.
Second, consider size, climate, and people. Some trainees love large cities while others hope to escape. Some like warm weather, while others crave four seasons. I love New Haven because it’s fun, affordable, and walkable. I love spring, summer, and fall, and even bundling up in winter. I love being able to bike, hike, and read by the ocean. I’m proud to live in a city that welcomes immigrants, and I love getting pizza and ice cream downtown and bumping into friends. New Haven’s size means residents can walk or bike to work, and because many residents live downtown, it’s easy to hang out- a lot.
Third, consider the details. Some programs still support 24-hour call, which we believe contributes more to sleep deprivation than education. Programs differ by catchment areas (neighborhoods within a city vs. regional draws like ours), patient populations (ethnicity, income, insurance), and special programs (like HIV, transplant, and new technologies). Programs also differ by salary, benefits, and support for medical and mental health, which are crucial to your well-being.
Fourth, consider resident engagement. How much do residents contribute to the creation of rotation structures, schedules, and special offerings? In our program, residents helped eliminate 28-hour call, ensure humane schedules, and develop the 6+2 block system, MAC program, and Distinction Pathways. Engagement in residency and GME governance helps trainees develop leadership skills, feel valued, and retain control over their lives.
Fifth, consider educational philosophy, particularly when it comes to autonomy. At Yale, we believe in graduated autonomy. At the start of the year, interns work intimately with talented seniors who teach them the basics of order entry, note writing, presentations, and procedures. Within weeks, seniors step back, encouraging independence as interns prepare to become seniors themselves. By third year, residents function like attendings, while faculty provide oversight to ensure they’re ready for independent practice.
Sixth, find your people. Applicants always ask residents if they’re happy, and they quickly discover that most residents are happy at most places. But you need to ask what residents are happy about and decide if what they’re happy about would make you happy too. Ask what they like about their program and what brings them joy so you can decide if their values resonate with yours. Ask yourself if the people you meet are the ones you want to be up with at three in-the-morning, and whether these are the people you want to become your lifelong friends.
Finally, let yourself fall in love with a program. Listen to your heart. Ask yourself where you will thrive. You deserve to jump and shout for joy on Match Day, whether you end up at your first, second, or third choice. You owe it to yourself to be happy, so listen to your heart, list the programs you love first, click the certify button, and let the Match algorithm work its magic.
A special thanks to the Welcoming Committee for all their support during this year’s recruitment. From the webinars to the postcards to the fabulous second looks, you really made us shine. I can’t wait to see the names of our new interns on Match Day, March 20.
Enjoy your Sunday everyone. I’m going out to search for signs of spring before editing an UpToDate chapter this afternoon.
Mark
P.S. Our hearts go out to the people of Iran and their families and friends in our residency community.
P.P.S. What I’m reading:
- I Grew Up Unvaccinated. Now I’m an Immunologist. By Elisabeth Marnik
- 197 died while homeless in CT last year — only three reached average life expectancy By Jacqueline Rabe Thomas
- Let’s Stop Getting Distracted From This Crucial Question About Exercise By Emily Oster
- One of the Bible’s Greatest Moral Revolutions By Shai Held
- What to Read About Iran Today By Jill Filipovic
- No snow days for these CT workers. When we stay home in a nor’easter, they say, ‘I’m ready to go.’ By Kenneth R. Gosselin (with a guest appearance by yours truly)
- Rise to Greatness By David Von Drehle