The match process has become a rite of passage, the complexities of which few appreciate until it is their turn to experience it. For Henry and Myers, it started shortly after tying the knot on November 3 at the Brazil Room in Berkeley's Tilden Park. After a quick weekend trip to Napa Valley, they headed off in different directions for interviews at some of the most competitive residency programs in the country. "We had so many interviews that first month that we were only together in our apartment for three nights," Myers said.

Once Henry and Myers find out where they will be working one month after graduation, the couple will be able to take a real honeymoon and start planning for their future careers. "I'm so excited to jump in and start learning the skills that I need to help patients," Myers said. "We'll finally get the chance to do what we came here to do."

For American medical school graduates, Match Day comes courtesy of the National Resident Matching Program (NRMP), a private, not-for-profit corporation that takes ranked lists from applicants and residency programs, compares them to one another and generates final matches.

The computer uses an algorithm to make the best matches possible given the preferences of both students and residency programs. It first assigns an applicant with his or her first choice. If a second student ranked that program first and was also ranked first by that particular program, the computer moves to the second choice on the first student's list. It continues moving down the list, until there is a match or the applicant's list is exhausted (see "The Scramble" below.)

The NRMP allows students to enter the match process as a couple. In those cases, the ranked lists are linked, so that the computer takes both preferences into consideration. Henry and Myers, who are participating in a couple's match, constructed their lists so that corresponding choices were in the same geographic location, though not necessarily in the same program. Toward the bottom of their 45 ranked residencies are options that would require them to work in neighboring cities and commute to a home in the middle. "Maybe I'm naive, but I'm optimistic that it won't come to that," Henry said.

The Great Computer in the Sky

Once the interviews are over, students begin the ranking process in which they have to weigh everything, from proximity to family and the personalities of their potential mentors, to impact on future career options and their personal fit into a new community.

The ranking process was agonizing for the couple. Henry has chosen to specialize in pediatrics, and Myers is pursuing training in obstetrics and gynecology. Both want to find programs that will train them to go into academic medicine and research in the future. Not an easy task, they said. To complicate matters, they have strong family ties to the West Coast. They were both born and raised in California and enjoy hiking, backpacking, skiing and river rafting. "We really struggled with what was important," said Henry.

The couple spent weeks vacillating between trying to stay on the West Coast or moving East. "Finally, two nights before the rankings were due, we sat up in bed and said ‘Let's make a decision,'" Henry recalled. Ultimately, their top four choices included two programs on the West Coast, one in the Midwest and one on the East Coast.

"I'm optimistic that we won't end up with something in the bottom third of our list," Henry said. "Whatever the Great Computer in the Sky decides, we'll be OK," he joked.

Like other UCSF medical students, the couple found ample support from faculty and staff while making their decisions. "We probably had about ten people we were relying on through this process," Henry said. Papadakis was among those supporting the couple in their unique effort to match together. "We try to individualize the support we give our students, because we know there is no one-size fits-all when it comes to career choices," Papadakis said.

The Honor System

Match Day was created in 1952 to provide a uniform date for decisions about residency selection for both applicants and programs. The goal was to eliminate the pressure that might otherwise fall upon applicants and programs to make decisions before all of their options are known. For the most part, the system seems to be a good one, Papadakis said. "It's not perfect, but it's infinitely better than having students negotiate offers from multiple programs," she said.

In addition to the 16,000 medical US medical school graduates, another 18,000 "independent" applicants compete for approximately 24,000 residency positions. Independent applicants include former graduates of US medical schools, US osteopathic students, Canadian students, and graduates of foreign medical schools.

In 2006, the NRMP enrolled 3,888 programs in the Match, which altogether offered 24,085 positions. In addition to the NRMP's Main Match, applicants to specialty residencies, including neurology and ophthalmology, participate in the San Francisco Matching Program.

The success of Match Day depends on both programs and applicants adhering to the NRMP's cardinal rule: neither must ask the other prior to the Match to make a commitment as to how each will be ranked. Instead, NRMP says on its Web site that "…each party may express a high level of interest in the other; however, references to how each will rank the other should be avoided and should definitely not be solicited."

The Scramble

There is one aspect of Match Day that few medical students wish to experience: The Scramble. On the Monday before Match Day, NRMP will notify students who have not matched to any of their choices. The next day, the service releases a list of vacant positions. Students then scramble for these residencies, enlisting the help of faculty members who contact their colleagues on the students' behalf.

"We have extensive services to help the students who don't match," Papadakis said. "But it is a trying time, with important decisions to be made." Faculty members advise students of their options, including spending a year doing research before reapplying. The scramble can last a few days but is generally over by Match Day.

Dana Myers said she experienced a lot of apprehension throughout the process. Now that the rank lists are in, however, she is relaxed and excited about Match Day. "After all of this hard work and all of these interviews and anxieties about where we're going to end up, now it's out there in the universe for a computer to decide," she said. "It's a surreal process."

Next week: Find out how our students matched!