March 15 is Match Day, and I find myself reflecting on many years of interviewing applicants, generating rank lists, and waiting to see which of them will join our program. The number of applicant interviews I have conducted is overwhelming after nearly two decades as a program director. I have met with roughly 3,000 medical students, and nearly all of them are now emergency physicians somewhere in the United States. It is incredibly humbling to think they were willing to spend time with me talking about their future.
The match is analogous to a crazy form of speed dating. Applicants walk into and out of my office in 30-minute intervals from October through January. I try to imagine working with this person for three years and knowing them for the rest of my life. Will I need to remind them to finish their work? What are they like when they are mad? Will they get along with attendings, peers, nurses, patients, and me? Will they complain about problems instead of trying to fix them? Do they have another gear when the ED gets slammed at 2 a.m.? The smallest perceived detail during an interview can tip the scale in one direction or the other, and decisions are generated that affect both of our lives long after their training has finished.
Of course, an applicant may be deemed a poor fit for a given program based on any interview. The opposite also occurs. All program directors meet applicants they immediately know will be rock stars. I cannot begin to count the number of times I have been excited about an applicant training with us only to realize he is likely participating in enough interviews to generate a reasonable rank list. But there are also many times I feel that we have a decent shot at a super applicant. They have their pick of programs, but I try to remain optimistic that we might be able to sway them in our direction.
It is after the interviews that one of the more interesting components of the match occurs, post-interview flirting. Each year the National Resident Matching Program sends out a long list of dos and don'ts, and all training programs are subsequently warned of repercussions if they commit violations. Obviously, the most important rule is that programs cannot promise or even hint at offering an applicant a position outside the match. Telling an applicant that he is guaranteed to match with your program is the road to perdition, so program directors have to come up with a way to communicate that they are interested, but they may not tell the applicant she is in.
On the other hand, applicants are not held to the same standard. The match is designed to protect them. Before the match was incorporated in 1953, training hospitals typically made take-it-or-leave-it residency offers early in a medical student's senior year. Facing this bird-in-the-hand dilemma, students did not have the ability to consider a wide range of programs in different geographic locations. With the match, all training hospitals must submit their ranked choices in February, and disclosure of who is going where is withheld until March.
A byproduct of this process is that applicants are free to tell any program they are their first pick. Statements like that are discouraged but not uncommon. I can certainly understand why they do this. Medical school graduates generally have about $250,000 in student loan debt. They do not have a job, and they are terrified they will not get one. They feel that anything that can tip the balance in their favor is a legitimate move, and this includes telling more than one program they are their top choice.
I have on many occasions been exposed to these post-interview flirtations. Examples include: “You are my favorite,” “I cannot wait to train at your program,” and “I am already looking at houses.”
But their names are not on our list when match day rolls around. I felt scorned by this in my early days as a PD. How could they lie to me? They seemed to really like us. Was it something I did?
But I realized over the years that nearly every applicant is going to feel pressured to stretch the truth. There are certainly many more applicants who felt jilted by our program. Applicants also think the program wants them when people are nice to them. Of course, the vast majority will not be at that program on the first of July when a program interviews more than 100 people for a handful of positions each year.
Now when I am asked each year who I think will match at our program, I just shrug.