01 April 2015

Med School Update: The Match and SOAP

We're going to Milwaukee, Wisconsin for residency!

No need to leave you in suspense. I know you thought you'd have to scroll to the middle of my post to find out. What you didn't know was that the real juice of the story is yet to come.

For those of you who have been following along with our story from the beginning, you may be thinking to yourself right now, "I don't recall seeing any stars in Wisconsin on Katie's application map." You would be right. Scott didn't apply to any programs in Wisconsin... which means we had to scramble.

1. To move or climb hurriedly, especially on the hands and knees.
2. To struggle or contend frantically in order to get something.
3. Applying and interviewing for unmatched medical residency positions in 48 hour time frame

Q: Why did the medical student order eggs for breakfast on Monday, March 16?
A: Because he was told to scramble.

*Ba-dum tssh*

Too soon?

Maybe. But we might as well lighten up the mood. Scrambling after the Match has a terrible connotation. I think medical students unnecessarily attach some of their self-worth to Match results. They apply to residencies, interview and are told from most every program "We hope to see you next year!", try to follow-up frequently with favorite programs, and have no choice but to put their trust in a computer algorithm to determine their future. Then when results roll around, and they are informed that they didn't match, it feels like they were dumped. How could it be that no one liked us as much as we liked them?

Both Scott and I were shocked to see that he had not matched with a residency program. He had excellent board scores, good grades, stellar reviews from rotations, and great letters of recommendation. He had even done audition rotations at sites we applied to and received encouraging feedback. We were sure that he would get into one of his top five choices for residency, especially since we had been told that students choosing to go into family medicine had their pick of residency.

My egg joke, however harmless, would not have been welcomed on Monday or Tuesday of Match week.

As many of you are likely curious how the scrambling process works, I will tell you. But allow me first to preface this process description with a fact - Good students can scramble into great programs. We feel that the residency program we scrambled into is possibly an even better fit for Scott than any of his top five match programs. We are ecstatic! Call it what you want, but we chalk up this happy detour to divine intervention.

There are two different matches, the allopathic match (MD/ACGME/NRMP), featuring residency programs accredited by the ACGME and the osteopathic match (DO/AOA/NMS), featuring residency programs accredited by the AOA. Osteopathic medical students may participate in either Match; and as mentioned before, Scott decided to apply for only programs in the MD match. This year was the largest allopathic match group in history, with a total of 41,334 applicants competing for 30,212 residency positions. More than 8,000 medical students were unmatched and participated in the Supplemental Offer and Acceptance Program (SOAP, a.k.a. "scramble"). Those numbers are for the MD Match only. The  MD scramble currently functions a bit differently than the DO scramble. In the scramble following the DO Match this year, students applied to and were interviewed for unmatched positions on a first come first serve basis. It is the definition of scramble, trying to be the first one to contact open residency positions and receive an offer.  Conversely, the main goal behind MD SOAP is to restrict applicant contact with residency programs through an application process, eliminating the first come first served “scramble”. I can't say how the DO scramble and MD SOAP will function in years to come, but I can describe our experience.

Ground Zero: On the Monday of Match week (MD), the medical students received an email letting them know IF they matched with a residency that they ranked. I was at work on Monday morning and Scott was in Hawaii in the hospital prepping for his sub-internship surgery rotation. He had just finished his early morning rounds when he received an email that he did not match and would need to participate in the SOAP. He forwarded me the email. Of course my heart leapt up into my chest as I imagined what he must be feeling. I immediately requested time off work to be available for him from home. Scott hadn't expected that he would need to take time off at all for the SOAP process, but I encouraged him to request leave from his rotation. Minutes later his school contacted him, knowing that he had not matched, and suggested the same, saying that time is of the essence as scramble decisions would be made in the next 72 hours. When Scott asked the surgery chief resident for an excused absence, the resident was very understanding, actually empathetic - the chief resident in Hawaii had even scrambled into his residency! He told Scott to take care of his future and not worry about returning to work until he was ready and able.

Scott's school had informed him that he could apply to 32 programs. He could apply to programs in the specialty we had chosen before or new specialties that had open positions. Their main advice was to not be selective, just try to match with any program. Once Scott and I reached computers, we logged into the NRMP match website in order to view available positions. Scott decided he would only apply to family medicine programs, as that was our focus for the past six months. There were 72 family medicine programs available with over 100 positions open between them. We briefly scanned the list and, considering the school's advice, applied to 26 family medicine programs without knowing anything about the programs except the program name and location.

Then we resurrected the spreadsheet. We had applied to what seemed like 80% of the available programs without knowing whether or not their program would prepare Scott for his desired career in sports medicine. Program curriculum became priority over location. Scott and I took the list of 26 programs from top-down and bottom-up, and we researched each program using residency websites and the AMA FREIDA database. We marked on the spreadsheet whether the program had sports medicine curriculum, OMM training, and noted if the program had a focus that did not fit with Scott's ambitions.

I'm not going to lie - day one of the SOAP was painful and an emotional roller coaster. However, working for 10 hours straight on researching gave us focus and determination that made us forget the email we had received that morning. Suddenly we were excited about finding the diamond in the rough. It takes some wading through the desert of programs with open positions to find a program or five that have matching desirable qualities. There were no interviews on day one of the SOAP, so there was less pressure to get the diamond before someone else stole it.

Interview Day: Again, Scott informed his rotation that he wouldn't be coming in to work on day two of the SOAP. I, on the other hand, had to work on Tuesday to distract myself from not being able to help. I made myself available to Scott by keeping my internet chat app up all day so he could type out updates between interview phone calls (I didn't want to tie up his phone line).

Scott was on interview calls all day long! He started receiving calls early in the morning - Eastern time and Hawaii time are not exactly compatible, but it was encouraging to be called. A couple programs had scheduled interviews with Scott on day one, but most of the interview calls came unscheduled. Initially Scott would receive calls from residency coordinators, like a pre-screen interview to see if he would be a good fit for their program. If good vibes were exchanged on the initial call, the program director would call him. Every program director wanted to know how Scott felt about their program, what he already knew about the program (booyah for the spreadsheet!), and whether he interested. Programs that recruited him hard made multiple (Scott says "like 50") phone calls on day two, including connecting him with current residents. It was clear that they were interested.

Not every program was so persistent. Of the 26 programs that he had applied to in the SOAP, Scott received interview calls from ten programs (this is where that "don't be picky" advice starts to sink in).

In EACH of the interviews, Scott was asked why he thought he didn't match. Specifically they asked why he thought he didn't match into PM&R (Physical Medicine and Rehabilitation specialty). Scott asked each of the residencies, what in his application had given them the impression that he was hoping to match into anything but family medicine. He had only applied to one PM&R program in the Match and had long ago decided he wanted to focus on family medicine.  He was told by each program, that there was a letter of recommendation in Scott's application had indicated he would be a great match for PM&R.

Now, we could play the "what if" game until the cows come home (what if we hadn't applied to PM&R, what if we had applied to more programs from the start, what if we hadn't narrowed our scope to the western US, what if he had followed up more frequently or bluntly with his favorites... you get the idea). Whatever it comes down to, there was something in the system that caused Scott to be ranked lower on competitive residency lists, and we didn't match.

Rounds of Offers: Wednesday morning following the initial Match notification brought the first round of offers from SOAP programs. The night before offers were extended online, Scott and I discussed scenarios. There are multiple rounds of offers, so there's always the concern that you might accept an offer in round one when a better program offers in round-two or three. However, the residencies that make you an offer in round one are basically saying "We want you, and we don't think you'll be available in round two." It would be taking a big risk to hope that someone else would decline a first round offer in order for you to receive a second round offer from a better program. Scott could take two hours to consider each round of offers. There were a few programs that Scott felt would make an offer in the first round, and when offers came through online he had two offers, both  good programs with sports medicine in the curriculum. The program in Milwaukee offered Scott a position in the first round. It was a front runner in our SOAP research, possibly a better fit for training than Scott's first pick in the Match. We accepted, of course.

Signing the residency contract in Hawaii

We feel blessed and could not be happier. I hesitated in asking Scott if I could post this story on the internet, because I knew how painful the initial Match results were for him. When I did finally ask, Scott said I could because he is going to a wonderful program and it doesn't matter how he got there. Agreed. There should be no shame in going unmatched and finding your own residency.

Now if you'll excuse me, I'm going to start planning my future. *insert mischievous grin*