100 Perfect Matches

From the March 10, 2023 issue of the Transformational Times

100 Perfect Matches

Kathlyn E. Fletcher, MD MA – Program Director, Internal Medicine Residency

Dr. Fletcher reminds us that regardless of where you do your residency, you will ultimately have a meaningful career with very close friends that you will meet in your program.

I’m terrible at cocktail parties.  In fact, I went to a black-tie gala two weeks ago and proved this point (again).  I was standing in a small group with my friend Jayne and a couple of her acquaintances from the banking world.  One of Jayne’s acquaintances had recently taken a new job, so I asked her how she was enjoying it.   She smiled and said, “When you love your work, everything is easy, right?” And before I could stop myself, I said, “Is it really, though?”  Jayne started laughing.  She knows me.  I really am terrible at small talk.

What I want to explain to them is that you can love your work, and it can still be hard.  That’s the thing about medicine as a career.  The work is usually hard.  The NATURE of our work is hard.  We interact with people on very difficult days.  Sometimes patients we see are in pain or very ill or very afraid or all those things at once.  When we are leaders, we talk with colleagues and learners who are struggling through personal issues or professional issues or both.  We meet people where they are.  We imagine their backstories.  We try to walk alongside them through their very worst times.  That is hard work.  But it is also meaningful.  And when we have meaning, we can have joy.  And when we have joy, we love our work. But it is rarely easy.  

In my role as program director, I am in that time of year between submitting my rank lists and waiting to see who will be my future interns. It is a strange space for program directors as we worry about whether or not we remembered to submit our lists (I literally woke up last night in a panic that I might have forgotten), wonder which of the candidates who said that they ranked us at the “top” of their list really meant it, and try to keep ourselves busy so as not to think obsessively about the Match (which I am clearly doing as I write this).  

I led a session this week with M4s on using art to develop empathy. In this session, the students choose pieces of art that speak to them and pieces that they think would speak to others.  One of the students chose a beautiful and dramatic painting by Homer Winslow called The Gulf Stream. In this painting, there is a man trying to navigate an extremely angry sea with a terribly damaged boat.  To make matters worse, there are sharks in the foreground.  According to the MET’s website, Winslow added a schooner far in the background, possibly to represent a glimmer of hope in the otherwise dire circumstances.  Interestingly, the students identified this painting as reminding them of this pre-Match period.  This really is a stressful time for them.

I have been thinking a lot about my daughter’s quest to find the perfect college.  She is a junior in high school and is just at the beginning of that journey, trying to discern what it is that she wants in a college experience.  She just finished her first college tour at Emory University.  She is anxious.  Her practice ACT tests are not (yet) in an “elite” range.  Her grade point average is amazing, but she is not in line to be the valedictorian of her class.  She has done some remarkable things, but she hasn’t patented an innovation or started a non-profit.  How could she stand out in the crowd?  

As other parents know, my ability to soothe her fears is limited to short bursts of time which she arbitrarily chooses.  I, therefore, have to pay attention so that I don’t miss my opportunities to drop perspective snippets.  The only message I have really come up with is one that I (ironically) took away from a cocktail party.  I think it has relevance to the Match.  Another couple with children in college commiserated with my husband and me about the stress of college applicatipons and early admissions and early decisions, etc.  But then, the dad said, “This is the thing: there are 100 perfect colleges for everyone.  The kids just have to believe that too.” 

Our residency program recently hosted an in-person second look day.  Because all residency interviews were virtual this year, we wanted to give applicants an opportunity to see Milwaukee, MCW and our residents in person.  At the end of the day, I told them not to worry too much about the Match. I told them that regardless of whether they ended up here or at the 7th place on their list…or if they ended up here and we WERE the 7th place on their list…that they were all going to be fine.  

So here is my message to the soon-to-be graduated medical students: Regardless of where you match, you will be fine.  There are plenty of perfect programs for you.  Wherever you land for residency, there will be things that you love about it and things that you want to change.  You will make lifelong friends.  You will learn and stretch and grow.  You will have hard days, and you will have meaningful days.  At the end of your training, you will be independent physicians.  

Also, once you start residency, it will never again matter where your program was on your Match list.  After July 1, no one will ever again ask you if you got your first choice of residency programs.  Not even at a cocktail party.  

Kathlyn Fletcher, MD, MA, is a professor in the Department of Internal Medicine at MCW. She is the program director for the Internal Medicine residency program and the co-director of the GME pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

The NRMP Couples Match: Three Questions for Two People Seeking One Match

 From the February 17, 2023 issue of the Transformational Times

 

The NRMP Couples Match: Three Questions for Two People Seeking One Match 

 

Alexandra Kershner and Andrew Sepiol

 

Ever wonder what it would be like to couples’ match? What is the good, the bad, and the ugly of the process? Here is our perspective on our experience, and some advice that hopefully can be helpful to you! As a couple are trying to match into OBGYN (Alex) and Internal medicine with the possibility of doing fellowship (Andrew).  

 

How did you and your partner come to the decision to couples’ match? 

 

For us, it seemed to be an easy decision because the most important thing to us as a couple was to match together, no matter where it was. However, it was still riddled with anxiety and daily conversations to try to calm the nerves.  

 

How would it work out for us? Are we both strong candidates? What would OBGYN being more competitive do to our match process? Would it give us the desired outcome of being at a strong program together? Would we even still be close together?

 

Even though the couples match created more anxiety and complexity to the match process, we decided the couples’ match was the best choice for us. Most of all, it would give us the best chance to stay together during residency and provide a way to make our relationship a priority alongside our careers in medicine. 

 

 

What has your experience been with the couples’ match process? Have there been any unforeseen benefits or drawbacks? 

 

The couples match takes an already 10/10 stressful process and turns it up to 11 because it over doubles the number of variables to consider, especially if one partner has a competitive specialty in mind (like Alex). Despite the stress, our couples match experience overall has been, as we would like to say, lucky. We have been lucky in the fact that we both received a good number of interviews individually and many of those interviews overlapped, so we didn’t have to worry about possibly ranking a lot of programs that weren’t close together.  

 

The largest benefit of the couples’ match was being able to draw on the strengths of each other’s applications to gain each other interviews at a few programs if one of us hadn’t heard from a program yet.  

 

Alex:  

One drawback is trying to interview while keeping in mind that you are looking for two people instead of just yourself. Of course, you should always vette the program for yourself, but I found myself always thinking about how we could function and be happy together at the program during my interview.  

 

Another drawback is when I interviewed at a place I absolutely loved, but my partner didn’t receive an interview anywhere in the area, so that program got taken off the board. Of course, that is a personal decision that occurred between my partner and me and probably looks different between each couple's match. It all comes down to values and what you are looking for.  

 

Andrew:  

I also wonder if applying as a couple hindered us from gaining interviews at a few places that we might have gotten as individual applicants. 

 

 

What do you wish you had known prior to undergoing the couples match? And what advice would you give others who are considering the process in the future? 

 

Andrew:  

There isn't much I didn't know about the couple match, simply because I wouldn't make such a big decision without carefully researching and thinking through the costs/benefits of it. I knew we wanted to be together and that we had to make it happen, so we did.

 

My advice to future couples is to carefully consider all the variables around each partner's strengths/weaknesses and how this may impact the match. I think it also helps to work with your medical school admissions committee or interviewing future candidates in general because it gives insight into how you're being evaluated. Knowledge about how interviewers think is invaluable because often they are going into the interview with an agenda with things they are looking for on a checklist. If you manage to meet those marks, great; if not, you might be able to advocate for yourself by wording your responses in such a way that you can turn certain weaknesses into strengths. My example is that I feel on our campus we must overcommit ourselves to doing things to be competitive. This is both a weakness because I have trouble with some obligations because of this; but also, a strength due to developing great time management and knowing how to prioritize my life in such a way that I can get things done.  

 

Alex:  

Since interviews are virtual, I wish I could have mentally prepared myself for how many interviews I would attend. Being on Zoom for an entire day of interviews and then getting back on Zoom for the resident social later that night five days/week was exhausting. I felt like I had to do many interviews to help myself and my partner feel comfortable in our couples match, because the reality is that you don’t know how it is going to turn out. When you are adding in another person, it takes it to the next level of complexity.  

  

 

Final advice:  

Be prepared to have hard conversations and make sure you give each other plenty of space to talk about aspects of programs that you loved or disliked because if you have those honest conversations, it will make your rank list the best for both of you.  

Here is extremely valuable advice I got from a resident: First, create your rank lists separately without the influence of one another. Then, once you have your individual rank lists, come together and discuss the compromises you are willing to make or the distances you are willing to travel. I think this piece of advice really allowed us to not overshadow each other’s preferences and really created a rank list that considered both of us and our goals.  

 

 

Alex Kershner and Andrew Sepiol are medical students at MCW-Central Wisconsin.