The Match, Part 3: Scrambled eggs, scrambled lives

Yesterday I received an email from the National Residency Match Program letting me know that I matched... somewhere. But I don't know where! That special secret will be revealed on Match Day, which is this Thursday, March 15th. In 2 days.

The logistics of Match Day are fascinating. Every senior medical student in the country finds out where they matched at the exact same moment on the exact same day. The results are posted online, or they are presented to you in some form of ceremony. At OHSU, there are envelopes laid out on a table, and at 10am (1pm EST), after a gorging yourself on a lavish buffet breakfast of srambled eggs and fruit plates, you are allowed to open them. I hear that some schools make you open your envelopes on stage and read the results outloud to everyone via microphone. That is nothing short of torture.

As if this period of waiting in limbo wasn't torture enough. Personal pergatory.

And speaking of inflicting pain... every year there are a few people who unfortunately do not match. All of the slots at the programs they applied to filled with people who were not them. If this happens to you, you embark on a frantic process that is known as "The Scramble." (I am not making these names up - it does sound like some sort of amusement park ride or a sorority hazing ritual, doesn't it?). This is the reason for the preminatory email that we all receive 3 days in advance - it is a courtesy to those who did not match.

The Scramble takes place on the two days leading up to The Match, aka today and tomorrow. If you have to scramble, you receive a listing of all of the programs in your field whose spots did not completely fill. Then you frantically send out emails and make phone calls and fax your application to any place that might have you. And if you match there, then you go there, sight unseen. Scrambling is not fun, but it happens.

The thing that is so odd about this whole process - besides the ranking strategies, the patented algorithm, the nationally coordinated reveal, the Scramble, and the 3 week period of excrutiating uncertainty - is that the match is contractual. By participating in it (and you have to participate - there is no other option), you are explicitly agreeing to a contract which requires you to go wherever the match places you. And this is an employment contract: you will from that moment on be a future employee of the hospital of the program that you match at. Your salary, benefits, and work hours are pre-established and non-negotiable. It is very weird.

A lawsuit was actually brought against the NRMP by a group of residents in 2002. They argued, I assume unsuccessfully, that the match system is "anti-competitive and thus a violation of anti-trust laws." Doctors and doctoring organization rallied against the lawsuit, claiming that the Match "levels the playing field. It makes everything fair. … Before the Match, there were deals made under the table. People were picked based on who they knew. If you destroy the Match, you're going to Neanderthal times." I guess I don't want to go to Neanderthal times, if you put it that way.

Anyway, right now I am waiting for some giant computer in some basement somewhere to make a lot of beeping and whirring noises and spit out a slip of paper with my name and my match result on it. This large, cold-war era computing mainframe machine, which is probably called something like the Mr. Matchatron 4000, looks like this:

Nickname: the Winds of Destiny

When Mr. Matchatron 4000 prints out my piece of paper, it will say my name in its slow, cold, metallic voice. Fee-oh- na. It will probably mispronounce my last name. But its words will be final.