Johns Hopkins Magazine -- June 1999
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JUNE 1999

Four years of medical school have come down to this single, defining moment. Pass the envelope, please...

O N    C A M P U S E S

The Match!
By Sue DePasquale
Photos by Doug Barber

"MATCHMAKER, MATCHMAKER, make me a match. Find me a find. Catch me a catch. Matchmaker, matchmaker, look through your book, and make me a perfect match..."

As the classic song from Fiddler on the Roof booms across the PA system in the Turner Concourse, a few selfconscious chuckles can be heard from the hundred or so Hopkins medical students who are milling about, munching on muffins and sipping apple juice. Many have friends and family in tow--husbands, wives, parents, babies. And though bobbing balloons and congratulatory banners lend a festive air to the mid-morning March brunch, there is an undercurrent of nervous tension.

Four years of medical school have come down to this: Match Day. The day when some 13,000 medical students from all across the country will find out where they will be spending the next several years of their lives as medical residents. In a few moments, the members of the Class of 1999 will file into Turner Auditorium, and, at precisely 12 noon, be handed the white envelopes that hold the secret to their futures.

Newlyweds Robert Blount and Hao Tran matched as a couple--she in pediatrics, he in internal medicine and pediatrics--and after 14 interviews, found it "amazingly easy" to agree on a ranked list. As it turns out, the young couple will be heading off to their first choice: University Hospital of Cincinnati.
Melissa Sparrow has arrived late to the brunch and is looking a little harried. In her arms she holds 2-year-old daughter MaryLouise. Her 5-year-old son, Russell, tightly grasps the hand of her husband, Ned (MA'91). Both children look eager to grab a balloon, and seem oblivious to their parents' preoccupation. It is crucial for Melissa to land a pediatrics residency in Baltimore, she says, which is why her top three choices fall in the area. (She won't be more specific than that. ) Ned is a professor of language arts at the Maryland Institute College of Art, and both children are happily ensconsed in school and daycare. "We don't want to move. It would be too hard on us," says Melissa, a onetime model in Paris and former English teacher at the Gilman School. Should it come down to it, however, the family is prepared to pick up and go wherever Melissa's envelope leads them--which could include the Robert Wood Johnson Hospital in New Jersey, or Children's Hospital in Philadelphia, where she has interviewed.

Against the far wall, Meenesh Bhimani stands talking quietly to a cadre of friends who have made the trip from Boston. Bhimani has done something virtually unheard of among Hopkins medical students. He has attempted to change career course--and at the last possible minute. Throughout medical school Bhimani intended to become an orthopedic surgeon. This past December and January, in fact, he interviewed at orthopedic surgery programs across the country. Then, in early February, he could no longer quiet the niggling voice that told him he was following the wrong track. "I was hoping to fall in love with orthopedics when I did my [orthopedic] rotations. I enjoyed it, but I didn't fall in love with it," he says. So, just two weeks before he was required to turn in his ranked list of orthopedic residency programs, Bhimani mustered up the courage to switch to the specialty he had fallen in love with: emergency medicine. He managed to squeeze in one emergency medicine interview before the deadline, and has ranked that program first on his match list. But Bhimani has also included several orthopedic surgery programs on his list--"just to be safe," he says.

Family affairs
David Cook and wife Jennifer sit off to the side on a sofa, each trying to balance a plate of food on one knee, a child on the other. While 5-month-old Nathaneal seems content to sit still on Mommy's lap, 3-year-old Emily is getting a little fidgety on Daddy's.
   David's residency interviews have taken him all over the country these past few months. Jennifer went with him on the first few, then decided it would be a whole lot easier--and less expensive--if she just stayed home with the kids. "I promised her a new couch with the money we would have used," he says, laughing. She smiles.
   Moments later, brunch forgotten, the young family is inside Turner Auditorium, jubilantly locked in a group hug. David's internal medicine residency, it turns out, will take them all to the Mayo Clinic in Minnesota-- much closer to their home state of Idaho than they are now.
   Says David ecstatically, "We already have a realtor!"
Kristin Chally and Brooks Stewart just flew in yesterday from a Colorado ski trip; tomorrow they're off on a 10-day vacation to the Virgin Islands, and then Chally will head to Taiwan for six weeks of training in infectious disease and traditional Chinese medicine. They are a peripatetic couple--throughout the winter they rarely spent more than a single night in a single city. Their exhausting round of residency interviews took them to two dozen medical centers, from Florida to California to Boston -- "more than anyone else in the class," says Chally, her nose sunburned from the ski slopes. The two aren't married; they aren't even engaged, yet. Nevertheless they decided to "couples match"--that is, tie their individual outcomes inextricably together. Unlike several other couples in the class, who would be content to be at hospitals in the same city or region, Chally and Stewart are matching to be in the same hospital in the same specialty: emergency medicine. That's the reason they went on so many interviews, and have ranked 15 programs on their list. "The odds," says Chally, "are definitely against us."

WHILE THE NATIONAL RESIDENT MATCHING PROGRAM has been around since 1952, the logistics have been streamlined over the last three years thanks to ERAS--the electronic residency application service. This year, 90 percent of all medical specialties take part in the national program; by next year, nearly every specialty will be linked, says H. Franklin Herlong, the kindly, bespectacled associate dean of student affairs. He has shepherded Hopkins medical students through the stomach-churning match process since 1989.

In the late summer of their fourth year, medical students in most specialties fill out a standard residency application, which can then be zapped electronically (along with their transcript and letters of recommendation) to residency programs across the country. Herlong advises most students to apply to 10 to 20 programs--more for those applying to specialties with few spots (like orthopedics, dermatology, or plastic surgery) and for the handful of students each year who apply as couples.

The residency programs then spend time sifting through their applicant pool to decide whom they'd like to invite for an interview. If you aren't invited for an interview, you stand no chance of getting a spot. The competition can be intense. The most prestigious programs at the most prestigous hospitals (where Hopkins students tend to set their sights) routinely get thousands of applications--and interview several hundred applicants--for two dozen residency spots.

Once the interview notices begin trickling in, the strategizing starts. While some programs send out invitations a month or two in advance, others give just a few days' notice. And all the interviewing is done during a finite period--mostly between early December and late January. "On the weekends of January 9 and January 16, it seemed like every place wanted to interview then," says Jonathan Gerber, who received invitations from 23 orthopedics programs. As a result of the scheduling crunch, says Gerber, students frequently "have to pick and choose among great programs."

Money can also be a limiting factor, since hospitals expect applicants to foot the bill themselves for all their travel and accommodations (with rare exceptions). "I have a lot of friends who live in different cities; that saved us on hotel costs. And we did drive a lot," says Chally, who did the marathon hospital tour with boyfriend Stewart.

The residency interview, say those who've gone through it, is similar to a first date--a chance for both the applicant and the program's faculty and chief residents to put their best face forward and to see if personalities click. Gerber, who ended up interviewing at seven programs (among them Penn, Yale, and Boston University), found the process grueling. Programs typically interviewed dozens of people a day, he says. "Some fell terribly behind, then they'd rush through the later interviews." At Harvard, the interview gauntlet took him to five rooms, each with a different panel of faculty, department heads, and/or residents.

Stewart says he's glad he took three months off from school to interview with Chally at more than two dozen hospitals. "The interviewing process itself helps you figure out what you want," he says. "I was asking different questions by the end than I was at the beginning."

Meenesh Bhimani ends the suspense for his parents, in San Francisco, with the good news that his decision to change specialties has paid off.
Once the interviews are complete, the strategizing gets even more intense--for both sides. By 11 p.m. on February 17, all applicants must submit to ERAS their final ranked list of residency programs. The residency programs also decide which students they want to rank, and submit their ranked list to ERAS. Then the computer goes to work, matching applicants to programs. One important rule of thumb: never rank a residency program you wouldn't be willing to join. Why? Because, unlike the dating world, there's no going back on a match once it's made. And the program highest on your list that accepts you is the place you're contractually obligated to go to, for at least a year.

Ranking is a nerve-racking game, and applicants can spend the days leading up to February 17 rethinking, and second-guessing, their list. Some are still tinkering right up to the 11 p.m. deadline. Matching as a couple can be particularly tricky--and can call for a measure of self-sacrifice. If one member of the couple is stronger, he or she may well end up matching much lower than by going solo.

There's always the uncomfortable potential for not matching at all--a plight that most Hopkins medical students don't have to face. Traditionally, says associate dean Herlong, 96 percent of Hopkins medical students match with one of their top five choices. But each year there is a handful of Hopkins students who don't match at all, he says. Sometimes it's because they've shot too high and neglected to rank enough "safe" programs; he advises students to rank at least 10. Other times, they've opted to pursue a highly competitive specialty, he says, even though they aren't "highly competitive" candidates.

Students who don't match find out the bad news on the Monday before Match Day, giving them three days to track down an unfilled spot. This period is known as "The Scramble." Says Herlong, "It's very unpleasant." Programs that have vacancies this late in the game tend to be "the bottom of the barrel," in the words of several Hopkins students. Herlong advises Hopkins students not to join The Scramble. Better to take a year off to do research, then reapply. Those who've followed this path have almost uniformly landed solid matches their second time around, he says.

By Thursday morning, March 18, the students who have gathered in the Turner Concourse can be confident that they have, indeed, been matched. The crucial question remains: Where?

A motherly

Vivian Pearson should be the one sitting here on Match Day, nibbling nervously on a danish as the minutes tick down to noon. Instead, it's her mother, Loy, who's doing the nervous nibbling. That's because Vivian is in Bangladesh, doctoring in a Muslim hospital. She isn't due back in the States for at least another month.
   "She wants someone to take my picture when I open the envelope, and she told me I have to look happy," says Loy Pearson, as she heads into Turner Auditorium. Vivian has interviewed to do a pediatrics residency. "Her list is all over. Her top choice is to stay here at Hopkins, but she could end up in Texas or Colorado," says her mom.
   After all the envelopes have been passed, Loy Pearson walks slowly through the concourse, stopping frequently to chat with various friends of her daughter's. Her smile looks genuine, and in fact, it is: Vivian, like about one-third of her classmates, will be doing her residency at Hopkins.
   How will Loy inform Vivian of the good news? "We'll have to send her an e-mail and hope she gets it!"

THE PASSING OF THE ENVELOPES is hardly an orderly affair. On stage, several top administrators stand holding boxes marked A-E, F-K, and so on. At the stroke of noon, students hustle down to the appropriate line to pick up their envelopes. Within seconds, the small auditorium becomes a whirlwind of shouts and motion, shrieks, hugs, and tears. Some students rip open their envelopes the moment they get them. Others take them off to a quiet corner. A few wait for the first wave of excitement to die down before making their way down to the stage. Everywhere there are cameras clicking, kisses being exchanged.

Up in the far right corner of the auditorium, Melissa Sparrow slips a paper out of the envelope, scans it, then lights up with an enormous smile before passing the paper to her husband. From a distance, it's easy to see his mouth form the words, "Oh, sweetie!" He envelops her in a hug. The Sparrow family, it appears, will be staying in Baltimore.

Meenesh Bhimani walks by, in search of a phone to call his parents in San Francisco. They were very supportive during those agonizing weeks in early February when he was debating whether to change specialties at the 11th hour. "Do what makes you happy," they told him. Now he can report to them that his gamble has paid off. He has matched with his top--and only choice--in emergency medicine: Johns Hopkins. He'll start his three-year stint in July.

Kristin Chally and Brooks Stewart wait until virtually all the envelopes have been handed out before they take theirs out to the concourse to open them in front of several friends. If they are nervous, they're doing a good job of hiding it.

Will they be heading to the Carolinas Medical Center in Charlotte, their top choice, in part because of its proximity to his family? or to Harvard, or the Hennepin County Hospital, near her family in the Midwest? Chally opens her envelope first, then scans the computer printout inside. For a second, she has a hard time understanding what she's reading. "I am really surprised!" she says after a second. "Wow." It's hard to tell whether she's pleased or disappointed; if she is unhappy, she's putting on a brave face for her friends. She shows the paper to Stewart, and he opens his own envelope, though by now he knows exactly what it will say. "So?" prod their friends eagerly. "So?"

"We are going to California!" says Stewart. He smiles, and then the two share a lingering hug. The University Medical Center at Fresno was fifth on their list, and they're excited about the prospect of being so close to Yosemite National Park and the Sierras. "It's very good," says Chally, as other friends come by to inquire about their match. "We're just surprised." She repeats again. "It's a huge surprise."

Surprise is the order of the day for Brooks Stewart (center) and Kristin Chally (right), who've landed emergency medicine residencies at Fresno's University Medical Center. After interviewing at more than two dozen hospitals, they weren't sure where they'd wind up.
Both Chally and Stewart say they remain comfortable with their decision to have matched as a couple. "If we were to do it independently, we'd have been much more secure thinking that we would match very high," Chally concedes. "But wouldn't it be a shame if I decided not to match with Brooks, and [it turned out] that he is the person who is right for me--the one I should be spending the rest of my life with? It would be more of a shame to miss out on that." Says Stewart: "The most important thing was, we wanted to be together. Whatever comes with that, comes with that."

He adds that they really would have been content to go to any of the 15 programs on their list. "In emergency medicine, the control over the quality of programs is pretty strong." That's a point associate dean Herlong has echoed, when asked how important a residency placement is to a student's future. Thirty years ago, he says, some of the newest therapies were only available at particular hospitals. If you didn't do your residency there, you might not get access to the latest techniques or technology. "That's not true anymore," Herlong says. Today there are "many good residencies."

Herlong gazes around the concourse, obviously pleased by the happy scenes he sees unfolding all around him. Over the long, nail-biting months his students spend preparing for their match, Herlong gets to know many of them very well. Their victories become his victories. Their pain, his pain. This year, for the first time, the Match Day results will be available online, at 1 p.m. Might this eventually spell the end of the traditional Match Day celebration? Might students in future years prefer to get the news alone, via their computer, rather than in a crowded auditorium? Herlong doesn't think so. There's something special, he says, about "sharing the moment."

As the event winds down, some students wander off with their families. Others remain in clusters, chatting and posing for pictures. At a round table, Melissa Sparrow sits talking quietly to a reporter from the Baltimore Sun, while her children burn off their boundless energy by racing back and forth between their grandparents and their father.

Melissa Sparrow (center) was nice months pregnant with son Russell when she took her medical school entrance exams. Daughter MaryLouise, 2, arrived during her final exam in radiology. "It's been amazing to watch," says her husband, Ned (holding Russell). Adds her mother, Patricia Marks (far right), "When she was little, I always thought she should be a doctor."
Hers is a compelling story. Medical school is difficult enough, but add two small children to the mix, and the difficulty rating soars almost off the charts. She was nine months pregnant with Russell when she took her medical entrance exams. Her water actually broke in the middle of the test. MaryLouise arrived three years later on December 4, 1996--the day of her final exam in radiology. In between she managed to win honorable mention in a national student essay competition sponsored by the Alpha Omega Alpha Honor Medical Society. (Her essay piece is set for publication in the fall issue of the society's magazine, The Pharos. She also took home the medical school's creative writing prize for an essay she wrote about losing her first patient, a baby girl.

"It's been amazing to watch," says her husband, Ned. "It's all been around the kids, because when she's home, they want her exclusively. There were no all-nighters--ever, really. Just a lot of quality time focusing, when she had time to focus." He smiles. "We'll have to see how next year is," he says, referring to the notoriously grueling intern year.

In July, Sparrow will begin her three-year residency in pediatrics--right here at Hopkins, her top choice.

Patricia Marks, Melissa's mother, is obviously thrilled that her daughter has landed at Hopkins. She hasn't stopped beaming since Melissa opened her envelope. "When she was little, I always thought she should be a doctor. She detoured a little, to teach English at Gilman, but when she decided to go to medical school I was excited." Marks pauses a minute to give her granddaughter a hug, before the little one darts off again. "I thought, This is exactly what Melissa should have been doing all along."