Nine months ago the online application system opened for Surgical Critical Care, the specialty in which J decided long ago he wanted to do a fellowship after residency. Eights months and two weeks ago, J submitted the Surgical Critical Care common application, indicating over thirty programs to receive it, most of them on either the East Coast or the Midwest in places we could reasonably consider living for a year. Six months ago, J flew out to Chicago for the first of what would be many interviews. Twenty-two in total, in fact, the last of which was one month ago. Two weeks ago, J submitted a ranked list of all those programs in hopes that the Match gods would look favorably upon the top of our list. In two days, we find out where J's education will take us after Residency. Surgical Critical Care is a sub-specialty of surgery that, in 2017, had only 219 applicants vying for 255 fellowship positions throughout the country. Of those applicants, 95% matched into those positions and 5% did not, and for U.S. grads in particular the results were even better: only 3 applicants did not make it into a critical care fellowship. SCC, then, is what is known as a "non-competitive specialty," which theoretically means less stress for the applicant.
Unless, of course, that applicant is my husband. I can't blame him for being stressed. Although not matching into a fellowship program after residency isn't nearly as catastrophic as not matching into residency after medical school, it can still be extremely problematic and dramatically change one's career prospects. This fear, founded or not, informed many of our decisions along the way. We chose to apply to as many places as we could possibly consider, at least outside of the American Southwest and South (neither of us handle heat or humidity particularly well). When the interview requests started coming in, J said yes to everything he could and weighed the risks - real or imagined - of declining anything, even if it was unlikely to suit J's interests. When more came in and it became hard to schedule them all, we still did everything we could to avoid declining or cancelling. Even after J said, mid-interview-season, "At this point it's not whether or not I'll match, but where I'll match," it did little to convince him that he shouldn't go on every possible interview that came his way. And his residency program, to its credit, supported this. There are many residency programs where applicants are limited to a small number of days they can take off for interviews before using their vacation days, and some aren't even given as much as that. While it is in a program's best interests that their graduates match into fellowships, creating a call schedule around interviews - many of which require reserving at least a half day for travel - is a logistical feat comparable to managing a floor-full of patients. That J was even able to accept and attend so many interviews is a huge testament to his program. Then there was the cost of all of this. Of the 22 interviews J attended, only three offered to pay for accommodations. For the rest we were on our own for flights, hotel reservations, Airbnbs, Ubers, and Lyfts, as well as a large portion of the food throughout the travel. Thank goodness for family and friends in a number of locations, who graciously shared their couches and guestrooms! When the last interview was done and the credit card sat smoldering in his wallet, it was time to create the rank list, which had been an underlying source of stress for at least six months. As for residency, applicants must submit a rank list that features programs at which they've interviewed organized by preference. Programs also submit their own rank lists of the applicants they've interviewed, and both lists go into a giant system known as The Match, which pairs applicants with programs (note: the capitalization here is part of its trademark, not just tongue-in-cheek commentary). Applicants do not have to include every program on their list, but here again the fear of not matching played a role. "I would rather match into my least favorite program than not match at all," J said. And so there were 22 programs on the list he submitted two weeks ago, any of which might be where we end up. We like to make ourselves believe that there is strategy to the rank list, or that the algorithm of The Match does, in fact, favor the applicants over the programs. We'd like to think that we are most likely to get our top choice, slightly less likely to get our second, and so on. So we labor over the list, taking into consideration all the many variables of our future:
And, not insignificantly, my happiness. When J made his rank list for residency he included me in the conversation - one of the first big cues I had for the future of our relationship. We agonized over that list, but when Match Day finally arrived and we opened the envelope to discover we had been completely unprepared for the possibility of matching below our Top 4, I was devastated. I moved with him to Brooklyn, but it was many months before I found happiness in my new home. J, understandably, is terrified for a reprise in the fellowship match. There are so many things that are different this time around. Fellowship is only one or two years, not five or six. We know it won't be in New York, and therefore any place we match will be smaller, more manageable, and perhaps more palatable to me than here. Given that there are more fellowship programs than applicants, his chances are significantly better in this specialization than they were in general surgery six years ago. His interviews have gone extremely well and he has come highly recommended by his current attending physicians. I, too, have changed. I have done this once before, and I learned a few very valuable lessons. I am stronger, more independent, and am better prepared to manage these vicissitudes than I was in 2013. I know better than to have any expectations at all about where we will end up. And I know I can find success and happiness no matter where we are. (And I know to find a therapist right away!) In two days the next piece of the puzzle that is our future will fall into place, one way or another. I can't promise I will be equally happy about all of the possible outcomes, but I know that whatever is coming next will be right for us.
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AuthorNashira is a music teacher and proud Small-Town Jew who, after surthriving six years in Brooklyn for her husband's surgical residency, is finally back in Wisconsin where she belongs! At least until the end of the two-year surgical fellowship, that is. It's a wild ride, and she's ready to tell you all about it! Archives
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