Match Day

Each year about 25,000 graduating medical school students from around the globe compete for approximately 21,000 U.S. residency positions. It’s an arduous process. Stealing time when they can from their studies, students travel the country interviewing at prospective programs, trying to visualize their futures, taking into account such considerations as the reputation of the program, the supportiveness of the staff, the proximity to family, and the inconvenience posed to husbands, wives, girlfriends, and boyfriends who would be dislocated by the move. Finally, they draw up lists, ranked by preference, of where they’d like to go. The residency directors, having interviewed in some cases hundreds of students, do the same. Both lists are then submitted to the National Resident Match Program.

The NRMP took control of the matching process in 1952, at the request of students who objected to the previous regime, an old boys’ network that tended to favor the well connected. Now the entire thing is done on a desktop computer running Windows XP, which with the help of a special algorithm settles everything in the space of four minutes, or about 104 lives per second. Still, in 2004, 7.1% of U.S. medical students didn’t match at all, and an even larger number ended up with something other than their first choice.

Two weeks ago, the graduating class of New York University School of Medicine gathered in Farkas Hall at NYU Medical Center to learn their fates. Four years of toil have lead up to this moment, which the students are ultimately powerless to control. In the giddy minutes before their futures were revealed, the students gathered in groups of three or four, by turns trying to suppress their growing excitement and railing against the system which kept them in such cruel suspense. Two young men whose relatively calm exteriors betrayed them as husbands or boyfriends stood comparing notes on how their better halves have coped with the anxiety of the last few days. “In her case, I think Ambien is the technique,” one said. His neighbor confirmed this finding. “That seems to be a fairly common technique,” he said. Nearby, another young man admitted that he hadn’t slept since 6:30 the day before. Had he tried Ambien? “Oh, no,” the man said. “Yesterday I was on call.”

Finally, three women appeared bearing boxes of envelopes and took their places behind a table, dividing the alphabet among them. “Come with me!” one young lady implored, rushing with her boyfriend to the back of the line. “I need you to hold my hand!” One by one the students received their envelopes and scampered off in search of a few square feet of space in which to confront the results of the almighty algorithm. Shouts began to ring out from around the room. “I don’t want to open it!” one girl said, her face a mask of anxiety. “Open it!” urged a friend. “No!” “Open it!” “No no no!” She vanished in the crowd.

Not all schools present match day as a laid back, communal occasion. Some simply make the envelopes available at the dean’s office, where students can sneak in to pick them up. Others take a more formal approach, summoning students to a raised stage, where the envelopes are handed out one by one, for maximum dramatic effect. The set-up at NYU seemed the ideal compromise, allowing students to choose their preferred degrees of privacy. One student sought the sanctuary of a quiet courtyard, around the corner from the growing fray. Here, at the bottom of a well formed by brick walls reaching up on four sides, a hidden generator produced a faint hum, and carp lazed on the pebbles in the shallows of a rock pool. Bracing herself, the student tore open the envelope. “Oh, I love you, Ron Rieder!” she screamed, addressing the clouds overhead and, also, the director of the Columbia residency program, which was first on her list. “I’m shaking. I’m shaking. Oh my God, I’m going to vomit.”

Back in Farkas Hall, Mariano Rey, dean of student affairs, a thoughtful man with gray hair, was wearing an oddly gloomy expression, given the generally jubilant atmosphere. “I didn’t match this year,” he said solemnly. Actually, he reported, the students of NYU did extremely well. Ninety-three percent got their top choices. ‘‘I can honestly say I cannot possibly imagine that another medical school did as well as we did,” he said. “And I’m not talking nonsense.”

“Oh, I love you, Ron Rieder!” she screamed, addressing the clouds overhead and, also, the director of the Columbia residency program, which was first on her list. “I’m shaking. I’m shaking. Oh my God, I’m going to vomit.”Later, Rey was joined downstairs, where lunch was being served, by Itzhak Kronzon, the chief of noninvasive cardiology. Kronzon looked around at the buzzing throng. “Nobody’s crying? Everybody’s happy?” “There might be one or two people crying in the bathroom,” Rey replied.

Recalling his own match day, 30 years ago, the dean vividly remembered sitting in the corner by the grand piano, hesitating over his envelope. He looked a bit misty. “There are so many emotions when you open up that envelope,” he said. “You wind up with five or six alternative scenarios in your mind, and once you get the envelope you’re left with only one. No matter how happy you are, there is also a feeling of loss.” By this point an exuberant student, flushed with catharsis, had stopped to listen. “It’s really not a pure response, is it?” the dean reflected. “For me it is,” the student said, beaming.

Dean Rey’s was perhaps the only somber face in the room. Even the partners whose lives were hitched to this decision seemed to be taking it with aplomb. “Last time I checked, my sales job doesn’t trump an MGH residence program,” one man said. “It coulda been Boston, it coulda been Philly,” another mused. His wife, bound for a pediatrics residency at Columbia, stood beside him. “He was nice enough to tell me he’d follow me wherever I went,” she said.

In the space of an hour, everyone had dispersed with their changed lives. Down the hall, in the hospital lobby, staffers from the Enid A. Haupt greenhouse, attached to the Rusk Institute on 34th Street, had set up a table selling houseplants. Were they aware that the students were matching today? “What’s that? They’re mating?” said one. Another shook her head. “I heard nothing.”