Where do four years of medical school leave you? With a good foundation in the biological sciences, in related fields like epidemiology, medical ethics and managed-care practice, with some exposure to clinical practice in several fields resulting in various degrees of experience gained. And, most importantly, the chance to go on and learn a great deal more about the care of patients on your way to becoming a licensed physician.
Medical school is, in short, only a beginning. Your next step will be as an intern or resident in one of the more than 4,000 teaching hospitals or other accredited postgraduate training programs.
Resident training provides the intensive, hands-on experience you’ll need to prepare for successful practice. The programs offered cover the entire range of specialties: single-year programs of general medicine or surgery for those still undecided about a specialty; so-called categorical positions for those who know what they want; transitional-year programs offering a mixture of specialties to individuals pursuing more advanced training, and so on.
This transition from med school to internship is one of the most complicated, important aspects of a medical career. You will be competing with all the other medical school graduates in the U.S., plus those from schools in other countries – and occasionally even residents in existing programs who want to change fields.
Sorting through this maze each year is a massive effort that is managed through the National Resident Matching Program (NRMP). Created in 1952, the NRMP saw 25,931 med school seniors seeking to fill 27,293 postgraduate year-one (PGY-1) positions offered in 2015 1.
The process of applying to internship programs is not unlike applying to college or medical school. It requires research and evaluation, and a plan for maximizing your chances of being matched to the program of your choice. Very important is the guidance and assistance you get from your medical school staff and faculty. (A medical school’s commitment and record of success in helping its students obtain their preferred internship positions should be high on your list of criteria for selecting a medical school.)
Begin planning for the internship match during your second year of medical school. By the third year, when you have a better sense of what interests you, seek the help of a faculty adviser. In the third and fourth years of most medical school curriculums, students are exposed to clinical experience in a variety of medical and surgical specialties. They even travel to other institutions for one- to two-month elective clerkships in their fields of interest – often a form of “auditioning” for internship programs. Throughout the last two years, students explore internship programs, often traveling to program sites for interviews.
The process officially starts when you apply to participate in the match, by July of the third year. In making this application, a student agrees to abide by the match process and not accept a position arranged outside the match. This agreement protects all participants from potential abuses in what is a very highly charged high-stakes process.
Between July of the third year and February of the fourth year, each applicant submits to the nrmp a rank-order list of internship programs to which he or she is applying. Medical school grade reports, letters of recommendation and board scores are forwarded. The NRMP then employs a complex algorithm developed over many years to match as closely as possible the applicant with internship program preferences. Results of the match are announced all at once, on Match Day, in March of the fourth year, when applicants find out to which program they have been matched.
For most applicants, the process ends there, with an assignment to either the first, second or third choice of internships. Nationwide, in 2015, 93.9% of MD school seniors and 79.3% of DO school graduates were matched. Overall, 78.4% of U.S. seniors matched to one of their first three choices, with 51.6% matching to their first choice 1.
For the relatively few who either don’t match or don’t like their match, there is still hope. Some programs don’t get enough applications to fill available positions. Others occasionally find that a matched applicant drops out. Once again, a committed and well-connected faculty adviser or medical school dean for student affairs can make all the difference in securing a suitable training opportunity.
Though it may seem somewhat daunting and inflexible at first glance, the match process is actually quite sophisticated and nuanced. For instance, there are special provisions for couples who desire to be matched to the same program, institution, city or geographic area. And regardless of the initial outcome, it’s always possible to re-enter the match in subsequent years.