medical draft day…the match

Monday, April 27, 2015

After months of speculation, the NFL draft of college players will finally happen this week. Fans will celebrate their good fortunes or bemoan their perceived loss as each of the 256 college players picked, are assigned to their new team. Meanwhile, the coaches, scouts and other management personnel may have their career longevity significantly affected depending upon how well the rookies impact the success of their new teams. But it’s not life or death, even if fans may think it is, when a future star wears a different jersey. Interestingly, the draft that has life and death implication concluded a couple of weeks ago, in anonymity, except for the tens of thousands of new doctors who learned their educational fate.

Graduating from medical school is a definite accomplishment, but rather a hollow one. The four years of undergraduate studies and four more years of medical school only qualify the newly minted MDs to open another door to access further training. The MD degree does not allow them to practice medicine; instead, it is the entry requirement for post- graduate training that can last three to seven years or more. This is residency training, so called because historically, the new MDs would literally live in the hospital where they trained. Graduating residency is the ticket to begin the practice of medicine and it all begins with the draft.


The National Residency Matching Program is the NFL draft of medical schools. Senior medical students decide upon their hoped for medical career, from primary care (family medicine, internal medicine, family practice) to specialties as diverse as obstetrics to dermatology to psychiatry to surgery. From there, it’s a search for the teaching hospital that has the program they are interested in pursuing, with hopes that the hospital residency program is interested in pursuing them. There are application forms, letters of reference, tours and formal interviews, no different than the NFL pre-draft evaluation process. The difference has to do with the scale of the draft.

There were over 40,000 docs-to-be in the 2015 NRMP draft trying to secure one of about 30,000 slots. The medical students list their preferred programs, the hospitals rank their wish list and a computer does the matching. At the end of March, the fate of each group is decided. The hospitals find out the quality of their new class of residents, while the medical students find out where their new home will be, come July.


Most applicants find a place to train, but some do not. The playing field is not necessarily the same for each applicant. More than 22,000 are senior medical or osteopath students who trained in the US. There are 6,000 American students who studied abroad and another 10,000 foreign medical grads. Add about 2,000 who have applied in previous years and the pool of hopefuls is complete. Those who do not get a spot in the first round, scramble to find a place to train. It’s just like an undrafted free agent who goes from team to team asking just for a chance to play. These students want and need a place to complete their medical studies, because without at least a year of postgraduate training, they do not qualify for a medical license, the golden ticket to care for patients.

While fans of the Buccaneers, Titans and Eagles fret about their first round pick and whether it is a Jameis Winston or Marcus Mariota, the NRMP is a real difference maker for communities. More often than not, new docs tend to live near where they train. They are familiar with the hospitals and neighborhoods, they may have started families and settled into the schools and community and have settled into homes. As well, the local doctors and hospitals have had years to assess their potential colleagues, and try to recruit the brightest and best to stay nearby.

The good news for 2015 is that about 13,000 of the 30,000 slot matched into primary care, meaning that 2018 will see a bumper crop of docs ready to cure the world, or at least help people help themselves become healthier. Their careers will span decades and touch the lives of thousands. And yet, those seminal decisions, affecting the lives of many generations, occurred in the obscurity of an NRMP computer program. If only it had the hype of the NFL and the daylight that draft day will bring.

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the other draft

Monday, May 12, 2014

For fans of the NFL, the draft has become a Christmas like celebration of hope for the future and dreams of success. Each team has evaluated hundreds of college football players to find those few who might bring success in the years to come. The team hopes to find the player with skill and personality who can add to team value. The player hopes to be drafted by a team that will allow him to have an impact and play almost immediately and will have playoff potential. The fans want a player who will be skilled, loyal to team and bring pride, dignity and a trophy to their city. Through rounds of intervie

While the NFL draft spectacle occurs under the bright lights of the media, a much quieter draft takes place every spring and the results will affect the local quality of life much more than a quarterback or linebacker. This spring, more than 34,000 medical students applied for a residency training slot, their first step to becoming a specialist after getting their MD degree. Half were from US medical schools, half were international graduates and all were looking for one of 27,000 places to get training in specialties ranging from pediatrics to surgery to radiation oncology. Few people outside of the medical community care about the match, but the results will affect their lives and the lives of their families for a generation or more.

The match dance is pretty simple. Medical students decide what kind of doctor they want to become and apply to residency training programs who will screen the applicants to find the ones that are the best fit for their needs and style. Students visit hospitals and go through rounds of interviews and rank the places in order of preference. Residency directors, sift through applications, recommendation letters and decide on their draft list. On one fine spring day, a computer silently matches the student with their new home. The match is binding, just like the NFL; one goes where one is matched. There are also a few free agents who don’t get matched but a few spots may become available closer to July, when the hospital academic year begins.

But why should you care what newly minted MD might show up to be trained at the hospital down the road? It seems that after spending, three to seven years of more in training, most docs tend to settle down near where they trained. That new medical school graduate may be looking after patients in your neighborhood for the next 30 years. Their kids will go to school wit hyour kids. The next soccer or little league coach may be your family doctor; the obstetrician may sing alto in the church choir and in a few cases, they may be your next Governor or Senator.

The statistics are in from the 2014 match and there is some good news for patients. Almost 40% of US medical students opted for training in primary care, either family medicine, internal medicine or pediatrics. The percentage entering radiology was the lowest in 15 years. The shift away from surgery specialties and radiology may signal that people enter medical school to develop relationships with their patients and that leads them to practices where they can again grow with their patients and their families. It also signals an altruistic change. Primary care is not a highly compensated specialty and while physicians are comfortably paid, the average medical student debt at graduation is north of $170,000. The benefits are not always financial when it come to looking after people.

The new crop of doctors will arriving by the end of June. They will begin forming opinions of their hospital, neighborhood and city relatively quickly. They will develop relationships and roots will be established. If the community is lucky, that doctor will decide to stay a lifetime. If not, it’s just like the NFL, there is always a hospital that will enter the free agent market looking to lure another doctor to their town, and the hope will begin again for the next spring draft.

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