A message from the dean

When I think of March in the College of Medicine, the first thing that comes to mind is not my NCAA bracket – it’s Match Day – the day that all our fourth-year students learn where they will be doing their residency training.
 
If you’ve never been to Match Day before, you truly have to see it to believe it. The excitement in the room as everyone reveals where they are going is really something to behold. You might call it our own unique form of March Madness.
 
It’s amazing to me to realize how Match Day has evolved over the years, and how it has become such an electric event. It was not nearly the well-orchestrated affair that it is today when I participated 40 years ago as a senior medical student at the University of Southern California.
 
The process to get to Match Day also was quite different, although a number of similarities remain. As today, we applied through a central application center and made interview visits from November to January. However, it also was a different world. There was no Internet or personal computers or cell phones.
 
Everything was done the old-fashioned way. We submitted our paper applications through the U.S. mail and corresponded with our potential residency sites by mailing letters and documents back and forth or – heaven forbid – by placing expensive, long-distance phone calls. The rates varied depending on what time of day you placed the call – the lowest rates were on weekends or after 11 p.m. on weekdays, but unfortunately no one would be in the office at those times.
 
Booking hotels was another headache. If you were fortunate, the program provided you with a list of hotels nearby. Otherwise, you had to locate a catalogue from one of the big motel/hotel chains and see if they had a property close to where you needed to go. There weren’t always toll-free numbers. You made reservations on your own dime, which again meant placing long-distance phone calls.
 
There is one aspect of the process of which current students will be envious. I was in medical school on the West Coast and decided that I was most interested in completing residency in the Midwest or East Coast.
 
At the time, Eastern Airlines, which is now out of business, had a promotion in which you could fly unlimited mileage as often as you wanted over a three-week period for the unbelievable cost of $400. The only catch was that you could not stay over 24-hours in a single city more than once in that three-week period, and you could only fly on Eastern. What a bonanza for a cash-strapped medical student and perhaps one of the reasons Eastern went out of business.
 
Atlanta served as the main hub for Eastern. No matter where I wanted to go, I invariably had to fly through Atlanta first. So, if I wanted to go from Detroit to Minneapolis, I would start in Detroit, fly to Atlanta, and then head back to Minneapolis. Needless to say, I spent a lot of time in airports, but managed to interview successfully at 11 programs in 17 days – total airfare cost, $400. Of course, I also went through the Atlanta airport about 13 times in those 17 days.
 
I was applying for residency in internal medicine. When you arrived at your destination, you were usually on your own. Nobody picked you up at the airport or covered your hotel costs or other expenses, except for lunch during the interview process.
 
As today, at each site I visited, there were usually between 15-20 other applicants going through their visits at the same time. During the course of the visit, you would typically get a couple one-one-one visits with faculty members and a tour. It also wasn’t uncommon to make acquaintances with students from other schools as you bumped into them at several interviews during the course of your travels.
 
I made more visits than many students because many of the faculty at my West Coast medical school were not that familiar with Midwestern or East Coast programs. My list included Minnesota, Michigan, Virginia, Vermont, Penn, Brown, Emory and Washington University in St. Louis. After all that, my first choice turned out to be Brown University/Rhode Island Hospital in Providence, R.I.
 
Part of it was geography. I had never lived in New England before, and I thought it would be interesting to experience it. But, more than that, I was impressed with Brown’s internal medicine program and how it blended community and academic physicians together.
 
As Match Day rolled around in 1980, we were anxious to find out where we were going. As is the case now, not everyone matches immediately and then needs to locate a program with openings. The process then was termed "the scramble" (currently Supplemental Offer and Acceptance Program, or SOAP) and had to be done via a series of phone calls.
 
Those students who do not match in the initial round are notified of their need to participate in the supplemental match a few days before the Match results are provided to all participants. Currently, UNMC Student Affairs lets them know in a confidential manner and begins working with them to explore options.  
 
Unfortunately, in 1980, schools were not always as sensitive to the stress of the Match process as they are today. At USC, we saw patients largely at the Los Angeles County Hospital. A good aspect of being at County Hospital was that medical students could eat in the hospital cafeteria for free. The bad part was that we could eat in the hospital cafeteria for free. You get the drift. On any given day, most of your classmates were having lunch there.
 
At USC in 1980, on the day that Student Affairs received word as to who in the class had not matched, I remember being in the County Hospital cafeteria when an announcement was made over the cafeteria’s public address system, "Will the following students report immediately to the dean’s office."
 
Their names were then read for all to hear. It was obviously unsettling and embarrassing for these students who had initially failed to match. Fortunately, all found spots. But, clearly this was not the way that students should be treated.
 
Certainly today, such an insensitive approach of notifying students of the bad news that they did not initially match would not occur. However, that doesn’t mean that the stress and anxiety associated with such news has gone away. Although 94-95 percent of students match in the initial round, with a very high percentage of those matching to one of their top three choices, that still means that 5 percent of U.S. students do not initially match and must run the gauntlet of the SOAP. 
 
Even more concerning is that for the last several years, as the increase in the number of U.S. medical graduates has markedly outpaced the increase in residency positions available, hundreds of U.S. medical students now remain unmatched at the end of the process. Thus, they face graduation from medical school – and the significant debt associated with it – without the guarantee of the ability to complete residency training and become practicing physicians. 
 
Increasing the number of residency positions in tandem with the increased numbers of medical school graduates would seem a simple solution, but this has not come to pass for a variety of political and economic reasons. Given the current and projected shortage of physicians in the years ahead, it makes little sense to graduate medical students who are unable to help meet the health care manpower needs of the future. Until that issue is addressed, this situation is prompting questions as to whether the Match process is broken and needs to be revamped. Stay tuned as that debate continues.
 
Obviously, times have changed dramatically over the past 40 years. However, just as was the case 40 years ago, there is an excitement as students from all over the country simultaneously open their envelopes to find out where they are going to be spending the next several years of their lives – and whether it means uprooting themselves from their current locations.
 
It is a life-changing moment. In many cases, it turns out to be the place where they will spend the rest of their lives. That’s a pretty big deal.
 
So, congratulations to all our students who successfully navigated their way through the Match and Match Day this year. It’s a memory that you will likely never forget. I extend my best wishes to all of you and wish you great success in the next stage of your road to becoming practicing physicians – wherever that may ultimately be. We hope for many of you that will mean Nebraska.
 
Before closing for this month, I wanted to take time to note that while many of us were caught up in the excitement of Match Day and our other professional activities, the tragedy of uncontrolled and widespread flooding was impacting some members of the UNMC community, the staff at our clinical affiliates, as well as their friends and families.
 
For those who were effected, our thoughts are with you as you work to recover from the physical and emotional challenges you are now facing. Please let us know how we can help. For the members of the UNMC community who have contributed their time and resources to assist our neighbors in this challenging time – thank you. In addition, to those who put in long hours and in some cases slept overnight in the hospital to be sure that our patients received the care that they needed, your dedication is what being a health care provider is all about.