This is a reader request post, but one that I think about often and so was happy to write about.
Medical school can be hard and practicing medicine is a demanding career. There are other programs and careers that are just as difficult, but medicine has it’s own unique set of challenges. Quite of few years of your life are spent in the hospital or clinic working your way up the hierarchy of white coats. It’s a lifestyle many wouldn’t choose to put themselves through, but is a necessary part of the process for those passionate about becoming a good physician.
I decided to go back to medical school when I was 25, and after a postbac year and a glide year, I didn’t actually start as an MS1 until I was nearly 28. Being a little older than the average student definitely prompted some extra considerations for me; the major two involving The Match process and the timing of starting a family.
Let’s start with The Match. For those of you unfamiliar with it, The Match is how graduating medical students are placed in a residency. It was started in 1952 with the goal of fairness, and is unlike anything else I’ve ever heard of. with a standard application during September of your fourth year, and the residency programs then select a percentage of the applicants to interview. After all the interviews, usually that following January and February, both medical students and residency programs rank their top choices – students rank programs and programs rank students. Finally, The Match’s algorithm goes through every single student applying to residency in the United States and matches them to a residency program, ensuring they get their highest ranked choice possible given how they were ranked by programs. It’s complicated, but this video does a great job explaining: The Match Algorithm Tutorial.
One key detail about The Match is that it is binding. On one fateful day in March of your last year of medical school, you get a letter telling you where you (hopefully!*) matched. That’s it. That’s where you’re going, even if it wasn’t what you were hoping for. No negotiating salary – just sign on the dotted line.
*There is a shortage of residency spots in the United States so some people unfortunately don’t match. It’s a terrible situation that could have it’s own post.
The concern for all medical students here (not just women) is that they basically have to pack up their lives and move wherever they match. Hopefully they interviewed well and ranked their lists strategically so that they are likely to match into one of their top choices, but that’s not always the case. It can get extra complicated when you’ve got a significant other, spouse, or family involved. A lot of flexibility and understanding is involved, as it often means people are finding new jobs and on occasion starting long distance relationships. For a couple that are both medical students, you can Couples Match to be placed in the same area, and that has it’s own set of challenges.
I think it’s common for medical students to worry that whomever they are dating or married to won’t be okay with this situation. Obviously that would be part of the conversation as the relationship gets more serious, but it can be extremely guilt-inducing to expect someone to put their lives and career second so that you can continue yours. I’d argue that it is maybe more so for females, since the idea that men have the “important” careers and are the providers for the family is still pretty engrained in some. Not that it’s not okay for men to support their families, but luckily for career-driven women the idea that that is the only way is fading.
For me, specifically, the idea of potentially moving at age 31 was scary. When I was considering all this at age 25 I was hoping to be in a serious relationship, if not married, by 30. (Considering I’m now 29 and single, I try to be more relaxed about life plans these days.) Even so, 31 feels a little different than the usual 26 or 27 for starting residency. People are more established in their lives and careers, and having to pick up and move might be a slightly bigger deal. Of course all of my worries were hypothetical, and so I couldn’t choose to not pursue my passion for medicine because of them, but still they did and do exist.
I’ve heard older students say that toward the end of the third year of medical school it’s “too late” to start dating someone. The reasoning is that there is no longer enough time to build a relationship to the point where it would be appropriate for your significant other to move for you. You have to rank your choices before you could say, “Oh hey, let’s make major life decisions based on each other.”
There is a small movement in the medical community working toward reforming The Match process, but it’s more complicated than meets the eye. I don’t know all the ins and outs, and so while I can complain about some of its downfalls, I certainly don’t have an effective solution. It’s just how it is for now, and I’ll go through it in a few years just like my parents did 35 years ago. It’s sort of a rite of passage, and one that medical students work tirelessly to ensure goes their way. It is a huge part of the stress of NBME Step One and Step Two boards scores, clerkship grades, research publications, leadership roles and all of the other aspects of a residency application.
I chose this and I don’t regret it one bit. I will continue to work hard so that I can hopefully Match to one of my top choices, and I’ll deal with any potential issues if and when they come up. I’ve gone through enough big changes in my life already to know that everything works out, even if it doesn’t seem like it at the time.
Alright, I intended to get this all into one post but I think that’s enough for now. I’ll share thoughts on starting a family next time! I’d love to hear your thoughts – whether you’ve gone through it, are in medical school now, or are thinking about it in the future!
Here’s some recent chatter about residency and The Match: