Every year in mid-March, tens of thousands of graduating American medical students learn where they will be going for residency and whether they will be cut off from their families, friends, and romantic partners. For many relationships where one or both people are in medical school, the “Game Day” of residence, which falls on March 17 of this year, may be the end of another match. This massive break is happening to many of my own classmates, medical school students across the country, and me.
For more than 70 years, the “Match” residency has been a unique but enduring aspect of medical education, pairing fourth-year medical students with a hospital-based residency program, where they complete three to seven years of grueling postgraduate training, supervised by attending physicians.
After applying and interviewing for potential residency programs, medical students submit a list, in order of preference, of the places they hope to attend. Residency programs also rank the interviewees who would most like to attend their program, and a Nobel Prize Winning Algorithm —which is also used to match eighth graders to their choices for New York City public high schools—generates the “most stable” matches based on all preferences entered into the system.
It’s hard enough to match where you want to train. For a couple to meet, either in the same institution or even in the same city, it is a great challenge.
On “Match Week” Monday morning, applicants are notified if they have matched a residency program. A select few will go unmatched, the nightmares of fourth-year medical students, and will enter a tie-breaking process once known as a “Scramble” to try to find a vacant residency spot.
At the end of the week, Friday, is Game Day, when students open a physical letter or email at noon notifying them where they’ve matched up and are contractually obligated to attend. Unlike other career fields, there is no way to collect multiple acceptances and explore one’s options, no ability to negotiate contracts before accepting, and very little room to defer and reapply.
Most residency applicants are in their 20s and 30s, and in the medical community, it’s no secret that the matchmaking process can make — and complicate — romances and future plans. Residents can expect to work up to an official limit of 80 hours a week (or more, off the books) and spend many weekends and holidays in the hospital. It’s a test for any relationship, but especially challenging when the match forces a relationship to go long distance.
By the end of September, he had applied to dozens of internal medicine residency programs. At the time, I was dating another medical student who wanted to match for a very competitive surgical specialty, and he had applied for almost 100. We had started our relationship in August, when we were collecting our applications and the possibility of our match. being broken by the Match was always in the background. Initially, he was more optimistic about our long-term prospects, while I was more cautious and internally questioned the wisdom of entering into a relationship during such a tumultuous season.
The application cycle is a battle of priorities. There are ways to exercise limited control over the outcome of the match, for example, not applying to certain shows outside of a preferred geographic region. But limiting the region and number of programs to which you apply can increase the risk that an applicant will not be matched, especially in more competitive specialties that recruit small numbers of residents. It can also prevent applicants from matching with a more recognized or prestigious residency program in another part of the country.
Applicants’ ranking lists are another way to express your preferences in the Match. However, the number of places each person applies to and interviews has increased in recent years as interviews have largely gone virtual due to COVID. This increases the unpredictability of the Party; it also forces applicants and programs to play more mind games to gauge each other’s interest. How much did this interviewer seem to like you? Has this applicant demonstrated sufficient willingness to relocate for this program? Did they smile enough, make eye contact on Zoom, or say the right things to indicate a positive impression?
For those of us who have been through the app-based dating wringer, it’s eerily similar, minus the one-year contractual obligation.
While the goal of residency matching is to maximize results for all applicants and all programs, there are actually some winners and losers. There are those that match your best shows, those that don’t match at all, and those in between, like my childhood friend’s husband, whose coincidence uprooted them both from the eastern US to Idaho afterward. from matching his eighth place show, which he later discovered had ranked him 80th out of a total of 120 candidates.
When both medical students in a relationship are applying in the same cycle, they have two options. The first is “couple matching,” an official and complex process in which the couple signs up to create a list of programs together, ranking the most ideal combinations of residency programs for both people, usually combinations of programs that meet in the same region.
Mathematically, as a partner in the tag team explained to me, this meant ranking over 100 combinations between him and his partner. Another friend and his fiancée are matchmaking couples who limit their requests to a single geographic region, allowing them to deal with fewer combinations of results.
Making a couple requires a great commitment in the relationship; if two applicants are at different levels of competitiveness for their chosen majors, one partner might be ranked lower in all of their desired programs, reducing the likelihood that both partners will be able to match in their highest-ranked programs.
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Those who choose not to pair up can apply as individuals while coordinating their geographic locations and ranking lists in hopes of ending up together without the limitations and complexity of the more official route. This approach allows for more individual freedom but also a higher risk of not ending up in the same region.
At this time of year in medical school, stories circulate of past couples breaking up after dating; They didn’t stay together, but one of the members felt that he had given up much more than the other in pairing. Although I’m not the type of person to sacrifice their entire personal life for their career, I made a vow to myself years ago to rank based on what was best for me and my career, in any relationship that wasn’t marriage or commitment.
When my then-partner and I separately spent a winter of interviews, it became clear that her residency options were limited and all were far from my favorite shows. We tried to put on a brave face for a while, but his initial optimism changed. In late winter, about six months after we started dating, our relationship came to an end, amicably and not unexpectedly, though with the standard amount of pain and recovery.
Our relationship wasn’t the first romantic casualty of this year’s green card cycle, and as we head into Game Day, I have a feeling it won’t be the last. Two of my classmates, both applying to surgical specialties, initially planned to match couples, but parted ways during interview season when they realized that the futures they envisioned for themselves and their careers were not aligned with each other.
Another friend had been in a relationship with a classmate for years, but they decided not to pair up. She told me months ago that she would be willing to stay together only if they coincided with programs on the same coast; However, as their ranking lists diverged further on location, they recently wrapped things up before game day even arrived.
Still, I’m holding out hope that my friends who are still in relationships and plan to get through Game Day intact. On March 17, when we all open our letters and the fate of our training is sealed, many students’ personal futures will become uncertain or tumultuous, but either way, we will be celebrating a major professional milestone on the path to becoming a physician.
Zhang is a fourth-year medical student at Columbia University looking forward to Game Day.