The High Drama of Residency Match Day

03/27/2015 02:12 pm ET | Updated May 27, 2015

Last week, more than 40,000 graduating medical students learned whether or not they were able to secure one of 29,000 residency positions in the country for further training in their overall journeys to becoming physicians.

Here is the CliffNotes version of how that works: Students apply to, and interview at, a reasonable number of residency programs, and at the end of that period, both parties indicate their preferences in the form of ranked lists to a third party -- in this case, the National Resident Matching Program. The NRMP uses an algorithm devised by mathematician and famed game theorist Alvin Roth, for which Roth went on to win the Nobel Prize in Economics, that creates thousands of pairings by optimizing for population-level best matches. (This algorithm is also what's used to match college students and fraternities, and kidney donors with recipients, it turns out).

This hyper-rational process, most everyone agrees, is necessary for an efficient outcome that remains relatively free of gaming. However, by virtue of its very design, it necessitates a giant simultaneous public reveal, that after months of waiting and lack of certainty, creates high emotional drama on the student-facing end. Match day ceremonies sponsored by medical schools around the country are characterized by similar ingredients -- high anticipation, synchronized opening of unmarked white envelopes, roving photographers, and a later chronicling on social media. Each of these are at once as superfluous as they are essential; no other profession announces job offers in this way, yet it makes for a symbolic and certainly memorable day, with students surrounded by friends, family and teachers, celebrating together after what has been a largely solitary journey.

Medical students fret about match day for months leading up to it. They complain that the time frame of interviewing in the late fall but only finding out their placements during spring is too efficient. Many bemoan giving up control over their destinies to a computer algorithm, a process of letting go that generates significant anxiety for a self-selected type A population. Finally, still others chafe at the public spectacle of match day itself. Sure if students match at their top choice institution, the public attention and scrutiny is well and good, but if not, then those very elements can be felt to be rather cruel. This past Friday, I heard from friends who did not end up in the same city as their significant other, or their family, but had to hide their wounds and smile for the cameras instead of being able to retreat and process their news privately. It takes force of spirit and a flair for stagecraft to put up a good face and avow joy when the reality is less than terrific.

But I think that the fervent drama of match day has a lot to teach us about something only slightly related. Examine the specifics of the emotional turmoil of the process, and one can find many analogies to that of being a patient. Bear with me here. Patients, when interviewed for their experiences with dealing with illness and of being admitted to the hospital, frequently claim the same trifecta of sentiments: they experience their illness through a loss of control, they frequently find the process of seeking physicians and care plans inefficient, and when poked and prodded by large teams of providers in the hospital, feel made to be a public spectacle. Moreover, very analogous to the binding, contractual nature of a match placement, patients don't get to choose the timing or nature of their illness. Life hits them in the face, and they must do everything they can to make their new circumstances work for them.

Of course, a true analogizing of these very different circumstances, matching for residency and falling ill, would aggrandize the former and trivialize the latter. One is characterized by an opening of new doors, new adventures, and the privilege of furthering a very respectable and energizing career path, while the other threatens life, functioning, and autonomy. Still, empathy isn't measured by one's personal range of experiences, as it is by one's capacity for imagination through representative proxies. Perhaps match day can be one such proxy.

I can still remember my own match day. For the week leading into it, I stayed calm only by actively trying to forget the significance of what was coming at me. I forced everyone hanging out with me that week to refrain from talking about it, to the point where I did things like take a separate cab from friends who insisted on coping by talking, and run to the bathroom when the topic came up at dinner. I was a neurotic mess. The adrenaline come-down after the reveal was similarly befuddling. I'd never cried tears of happiness before, but I'd also never needed to skip a meal because I was afraid I would throw it up. I was soon flooded me with questions -- "Where did you match?", "Was that your first choice?", "Are you happy?", "Aren't you so relieved?" -- from both close friends and family, but also from a whole range of acquaintances, that it created a strange intimacy between me and hundreds (as though the emotional chaos was a cake that everyone could binge on).

It was only in the privacy of my apartment, later that weekend, that I could finally, calmly take a good, long look at what the events of that Friday would mean for the next three years of my life. I no longer felt as inflated.

I could finally hold my head and take a deep breath.