When a med student’s future all comes down to an envelope
The energy in Old Cabell Hall was palpable as the crowd counted down the minutes until noon—the moment when the 136 fourth-year medical school students gathered in the auditorium would tear open envelopes revealing their futures.
The same tension was unfolding all across the country. Tens of thousands of med students waited to receive the news they’d been working toward these past four years: the assigned location where they would spend their residencies, the next crucial years in their quest to practice medicine.
Welcome to Match Day.
At UVA, names were called randomly—drawn from a bag—which only heightened the tension of the unknown. With each name, the waiting cohort betrayed a little more nervous energy in enthusiastic cheers.
Mackenzie Sullivan (Med ’19) received his envelope early in the one-hour countdown and agonized until noon. He finally put the envelope down “because it was burning a hole in my palm,” he said. He had an entire family cheering section: nine guests, including his grandparents, goddaughters and his partner. As class president, he’d planned the day’s activities and from the podium had wished everyone luck. But now all he could do was wait.
After receiving his envelope, Anthony Wiggins (Med ’19) left the seating area reserved for his class and sat in the back of the auditorium, leaning against his fiancee, who had flown in from California. Wiggins had been convinced since middle school that he would become an orthopedic surgeon. His top residency choices were on opposite coasts, so the two were putting off wedding plans until they learned if they would be in New York or San Francisco or …
Brielle Gerry (Med ’19) articulated the gravity of the moment: “You can’t back out once you enter the match process—compared to the way you find jobs and do your job search and have multiple offers. It’s not like that. You quite literally open an envelope and go where that envelope says.”
The making of a doctor
Everything seems to funnel down to a few minutes and a few lines in an envelope, but the matching process has its roots at the very beginning of medical school. The making of a doctor launches with two years of classes and training in basic procedures, followed by an intense year of rotating through specialties. Some students arrive at UVA with their specialty set in stone. Others lean toward one specialty, only to change their minds during third-year rotations. Some students discover that certain specialties are a more natural fit for their personalities, skills and desired lifestyles.
Wiggins’ pursuit of orthopedic surgery made sense because he wanted “to work on identifiable problems that have a tangible solution.” Gerry switched from pediatrics to general surgery because she appreciated the hands-on approach and intangible element of trust “when you’re responsible for opening a person’s body.”
Once students home in on a specialty, the fourth year of medical school ramps up to a frenzied pace as these almost-doctors begin applying for residencies and waiting for interview invitations. According to the American Medical Association, students apply to an average of 36 programs and interview in person at an average of 12.
Each student then ranks residency programs according to preference, knowing that each program is also ranking them for a limited number of spots. All lists are submitted to an impersonal computer algorithm, where the magic happens: The Match. (The two economists who created the algorithm for the National Resident Matching Program won a 2012 Nobel Prize for the complexity of their research.)
The goal is to get students matched to the program highest on their list that also requests them—the results to be revealed via envelope on Match Day.
Couples who want to attend residencies near each other can request to be matched together, which introduces an additional level of complexity. Santana VanDyke (Wise ’14, Med ’19) and her longtime boyfriend, Justin Palmer (Wise ’12, Med ’19), are pursuing dermatology and anesthesiology, respectively. Their dream was to be assigned to nearby programs and eventually get engaged as they work through their residencies.
Altogether, the couple submitted a list of 250 possible combinations based on their top choices, plus a separate one-year internship for VanDyke. And then, like their classmates, they waited. Which was “pretty agonizing,” she said.
VanDyke was also concerned she might not match at all for a residency, because of the competitiveness of dermatology programs, which take only a few residents at a time. She knew that not all medical students are accepted into a program. In 2019, a record 38,376 medical students applied for 35,185 available spots, according to the National Resident Matching Program.
And it all comes down to this
Back in Old Cabell Hall, the last envelope was finally handed over and Associate Dean Dr. Megan Bray (Res ’99) gave the go-ahead: “It’s precisely 12 noon.” Initial cheers gave way to the concentrated rustling of envelopes being torn open, followed by a release of energy and emotion. Some students screamed or climbed over seats to announce their destination to friends or family members. Others quietly hugged. One young student sat with his wife and toddler as his wife both smiled and wept.
Simone Reaves (Med ’19) could barely get her envelope open, her hands were shaking so much. “When I opened the letter I was overwhelmed with emotion,” wrote Reaves, who was matched for OB/GYN at Thomas Jefferson University Hospital in Philadelphia. “Suddenly everything was real and concrete!”
Sullivan, the class president, matched at Harvard Integrated OB/GYN; Wiggins for orthopedics at the University of California, San Francisco; and Gerry for general surgery at the Medical University of South Carolina.
Palmer and VanDyke left their seats to open their envelopes next to their parents. Palmer matched at Dartmouth-Hitchcock Medical Center in New Hampshire, and VanDyke matched for both internship and residency at the University of Vermont Medical Center. The two will be only an hour and a half apart. “We were so relieved when we realized that we had matched so close to one another,” VanDyke wrote after the event.
Twenty-one students from the Class of 2019 were set to begin residencies at UVA; the others would rapidly line up housing in their new cities as they prepared for graduation.
This moment, however, was reserved for celebrating.
To escape the deafening noise level in Old Cabell Hall, Gerry fled into the sunshine of the South Lawn to text and make calls to family members who were coming later that night.
“My phone is blowing up right now, and it’s so exciting,” she said. “I can’t believe this day is here.”