“Should I stay or should I go now?”
I don’t think Mick Jones or Joe Strummer knew anything about the NRMP or National Resident Match Program – but their words echo in my head as I think about my journey from medical student to pediatric resident in the early 1990’s. The decisions I made that late winter were many but they boiled down to remaining in my medium sized southeastern hometown, or venturing to a bigger pond. St. Christopher’s in Philadelphia, Emory in Atlanta, Children's National Medical Center in Washington, DC were three of the several pediatric programs that I interviewed and interviewed me. The big city had an allure for me, and each successive site convinced me that I could swim in a bigger location.
But I had my doubts. Could I learn to draw all the labs on my admissions? Would that be educational or just scut? Would I be safe as I headed to my car after 30 hours (these were the pre-mandatory work hours days) in the hospital? Would the traffic overwhelm me? Could I afford to live on a resident’s salary? How would I find a roommate if I needed one? Did all the “perks” of a program really matter? Would I have chemistry with this program or that one? Maybe that seems like an odd question, but I was about to spend the majority or my life inside the walls of a hospital. I needed a sense of connection to this team I was about to join. For the next three years, I would be guided by physicians who could determine some part of my professional future with their advice and evaluations. In return, I would be expected to be a team-player with my fellow residents in the care of patients. Could all of this come down to a gut decision? For the one time in my life – footloose, unbeholden and young, my decisions affected only me.
Despite some early interests in triple board programs (Pediatrics/Psychiatry/Child & Adolescent Psychiatry), I interviewed in and ranked only categorical Pediatric programs. Writing that rank list was one of the hardest career moves I’ve had to make. (Taking my first job in the rural Southeast over the chief residency was a close second) All indications were that my home program at a children’s hospital would welcome me into their fold.( Reassuring smiles & nods from attending physicians) No guarantees, though. That would be against the rules of the match. The alternative was to take a risk and rank St. Christopher’s Hospital in Philadelphia number one – a program where I’d had a second interview and hopefully made an impression. Again. No guarantees. No assurances. Pick my home program and have familiarity and the acquaintance of at least two thirds of the residents. Or, pick the unfamiliar, riskier choice that could potentially jettison me into a fellowship or academic medicine.
My own Match Day was anti-climatic after I submitted my list. Most applicants for Pediatric residency positions get their first choice. I was no exception. Yet I was still jittery on that Wednesday. My class had spawned five couples who were trying to match as couples. My nerves felt their anxiety and my own. What if some computer glitch matched me in Philadelphia or Washington, DC? Was the decision really about location or was it more about envisioning the future of my career? Was it about having a high-powered pediatric career or a more balanced life that included pediatrics? Guess what? I’m still working on that balance, and some days I have thoughts about the fellowships I could have applied for, but I wouldn’t have written that rank list any differently.