The Intern Blues(15)

Friday, July 26, 1985

The past few days have been nothing but a blur. I was on last night and I managed to get some important sleep. My grandmother’s much better; they’re probably going to send her home over the weekend. And my time on Children’s is coming to an end. Of course, I’m on the last day of the month. You can almost set your calendar by my on-call schedule. And then on Monday, I start on Infants’. I have the feeling the shit’s about to hit the proverbial fan. Infants’ is a bitch!

The only good thing about all this is that I know I’m not going to be on the first night. The chiefs may have decided they don’t like me for some reason, but they’re not crazy. They couldn’t make me work two nights in a row. But actually, since I’m on Tuesday, I get a weekend off next week. Weekends off, I remember those; that’s when you get to visit your apartment for two whole days.





Bob


JULY 1985



You might wonder how these three interns wound up coming to our little corner of the world. It is not fate or destiny that brought them here, but rather the bizarre intern mating ritual known as “the Match.”

All of medical school—in fact all of life—is nothing but preparation for the Match. It’s the first of many horrendous and inhuman experiences to which house officers are exposed. In other professions, a person who wants a particular job submits an application and a résumé; the person goes on interviews, trying to convince the employer that he or she is right for the job; if the job is offered, the person has the right to accept it and begin work, or to reject it. But this system, good enough for American business, apparently is too simple for medical residency training. After all, there’s no torture involved.

The search for the perfect internship begins early in the summer before the medical student’s fourth and final year of school. The student interested in pediatrics or internal medicine fills out as many as twenty applications for residency programs. He or she then spends a month interviewing at hospitals around the country, asking numerous questions of the house staff and attendings, trying to get a feel for the place. After narrowing the field down to a few top choices, the senior arranges to do “high profile” rotations at these hospitals. These rotations, often a subinternship in an ICU setting, give the student the opportunity to work himself or herself sick, taking call every third night, in hopes that somehow the director of the program will notice and think highly of him or her and possibly place the person near the top of the match list. But I’m getting ahead of myself.

Here in the Bronx, a committee of pediatric faculty members is attempting to select an outstanding group of interns from a pool of hundreds of applicants. For our entering group of thirty-five, more than 225 senior medical students were interviewed in the fall of 1984. This interviewed group was ranked from one to 225 on the basis of grades, letters of recommendation, the impression made during the applicant’s interview, and performance during these elective rotations spent at one of our hospitals.

The fun of the Match actually begins in January. Each applicant sends off a list of programs to which he or she has applied, ranked from first choice to last, to the National Intern and Resident Matching Program (NIRMP) in Illinois. Simultaneously, the director of each program submits a list ranking all senior students who have applied for a position. All this information is fed into a computer and the machine grinds out the Match, coupling applicants and programs. One might think that this chapter of the matching procedure would end with a friendly letter mailed from NIRMP and received anonymously and privately in a mailbox some days later. But no; nothing in an intern’s life is that simple!

The results of the computer’s work are stored in a vault and released in the middle of March. The senior students from each school are assembled in a centralized location, one usually designed to maximize feelings of anxiety and hopelessness, and the envelopes are distributed one by one by the person, usually a dean of the medical school, charged with guarding the secrecy of the Match. A name is called, the student rises and slowly approaches the front of the room; the envelope is handed over, it’s cautiously opened, and the student either sighs a sigh of great relief because his dream has actually come true, he’s matched at his first choice program and as a result his future is assured, or he lapses into an immediate and frightening anxiety attack, often complete with hyperventilation, because he’s gotten his third, or fourth, or, God forbid, fifth choice and is going to have to work at a hospital with a bad reputation or, worse yet, at a place that’s considered “anti-academic” and no matter how hard he works in his internship, his residency, or his fellowship, he truly believes that he will never be able to become a true success.