"You've matched to a Preliminary position."

by Brittany Bankhead-Kendall, M.D, M.Sc.

Every medical student looks forward to "Match Day." Even non-medical people know what this "match day" is . . . . they hear about it from us, read it on our Facebook posts, and see our blogs about it. We're obsessed with it. What happens, though, when "match day" isn't all you hoped and dreamed it would be?

As I've written before, my husband and I tried to couple's match our fourth year in medical school and were unsuccessful. He obtained a residency position outside the match, and I matched to a preliminary position.

To any hopeful medical student, matching a preliminary position is bittersweet. It's devastating that no one "wanted" you long term. It's frustrating because you will, quite literally, be starting the match all over again in a few months time. And mostly, for me, you will go for another year of your life in a large amount of debt, after thousands of hours of very hard work, with an insane amount of knowledge... and no career to show for it. None. Nothing. Just a degree that says "M.D." but that you could never actually DO anything with. I, too, was devastated.

But instead of drowning in my devastation, I chose joy: Joy that I matched at all. Thousands of hopeful medical students don't match each year and are forced into non-clinical jobs that they did not really aspire to. I also found joy in matching to a preliminary position in my field of choice; I was very happy to be a surgical preliminary resident.

I chose to use my preliminary year as a gift to see if surgery was really what I wanted to do for the rest of my life. What an amazing thing! How many of our colleagues actually get to "try out" their chosen profession for a year, with no strings attached, to see if it is something that they really like? As a medical student, you have 6-12 weeks of watching residents do what you THINK you want to do, and deciding to make a career of it. I was able to walk the walk and talk the talk (and work the work :) ) to decide if this was really what I wanted to do.

When I matched to a preliminary position I communicated to my new chief residents that I wanted to be thrown into the very most difficult rotations (busiest, hardest, longest hours, however they wanted to take that request) at the beginning of my year- in July and August. This would give me an up front, real time, on the front lines view of General Surgery, as well as expose me to the most intense months that I would be encountering. For me, these months were very busy and very overwhelming at first, but I was absolutely positive at the end of it that I was supposed to be here, and I was supposed to be doing surgery.

Letters of recommendation are very important in your preliminary year, they are basically the only thing that will have changed between last year and this year's application. You should have the maturity and the responsibility to seek these early and form relationships with faculty that allow them to easily communicate how dedicated and just how good you actually are at what you do. I love my job, and that was evident to my attendings. Also important: having an answer to "So what happened last year?" I was asked this on almost every interview I went on. Be prepared for being offered about half the number of interviews you were intially offered your fourth year of medical school. Save up money on your small resident's salary for interviews. Talk to your program director early about expectations for vacation time to be able to travel for interviews. Be nice to your co-interns because they will have to cover your call now while you travel. You are no longer enjoying a lax 4th year as you travel, you are in the thick of intern year and you will be tired. I can almost guarantee that at one point during interview season, you will walk off a night call and walk straight on to a plane. The next day you will need to look as fresh and excited as those chilled out fourth years who are interviewing around you.

The absolute best part about interviewing for a categorical position as a preliminary intern: I knew my stuff.  I know what to do, and am not frazzled, when a trauma comes in to the Emergency Department and starts decompensating right in front of me... because I've done it. I walked into every interview with complete confidence that this was going to be my career, 100%, and I was going to be VERY good at it... because it's been my job for a year now. I discussed the parts of being a surgical resident that I love that medical students don't have a clue about yet... because I'm here when everyone else goes home.

Match Day 2014 was a success for me. I matched to a categorical position. I've got a career. I'm so, so happy.

If you matched to a preliminary position this year, keep your head up. Keep your eyes on the prize. View it as an opportunity to try out a field in medicine or surgery for a year. Take the high road. Work your butt off.

You'll have a career soon, too. And it will be everything you'd hoped it would be.

~~~

Brittany Bankhead-Kendall, M.D, M.Sc. is a PGY1 preliminary general surgery resident at Methodist Dallas Medical Center in Dallas, Texas and will be a categorical resident at St. Joseph Mercy Oakland in Pontiac, Michigan this summer. She obtained her M.D. from Ross University School of Medicine, M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She enjoys being a surgical intern and mentoring medical students. In her personal time she enjoys spending time with her husband and son, interior design, international travel, and Texas Aggie football.

Unconventional: Our Couple's Match Story

by Brittany Bankhead-Kendall, M.D., M.Sc.

Match Day 2012 was supposed to be the best day of our lives. Or one of them, at least. But it was so, so not. Monday morning my husband and I left our respective rotations around 11:45am and hopped into our SUV in the hospital parking lot in anticipation of the noon email saying we had matched. We wanted to celebrate that together. My email came: "Congratulations! You have matched to a one year preliminary position." I was devastated. But it got worse. My husband's email came: "We're sorry, you have not matched to any positions."

Can that happen? Did that just happen? I didn't think that was possible. Our numbers were right. We had plenty of interviews. We were matching Emergency Medicine (him) and Surgery (me). A difficult match, but not an impossible one. Right?

He was the better candidate, but we thought Surgery was the harder match. So at match choice #18, after all of our same city match choices, we listed a match-no match option. The thought was that in this certain city we chose, surely he could find something to do for a year. A big city, close to my family, lots of options. We assumed he would at the very least be able to find a preliminary surgery spot at one of the four hospitals in the area. Prelim surgery spots aren't hard to find, right?

We drove straight from the hospital parking lot to a McDonalds and hooked up the laptop and filled out his SOAP application. He applied to all the Surgery Prelim spots in my city (the NRMP will tell a couple, in a match-no match situation, the city of your match). Tuesday, Wednesday, and Thursday came; no interviews, no offers. Match Day came and went, we "celebrated" at home with our baby boy and my parents, and occasional tears.

Then we looked for research positions for the year for him. And... Nothing. We tried, we weren't even picky. But he was over or under qualified for anything we found.

Then one day, out of the blue, he got an email inviting him to interview across the country for a position in Emergency Medicine. He got the position. And yet we struggled with it. Was this a temptation that he should pass on? Was this a blessing? Was it great for his career at the expense of our family? Would we be able to survive without each other? Could I be a surgery intern, with our BABY, without him?

Ultimately, he took the position. We're tough. Yes, he and I are tough. But what I also mean is that we women physicians are tough. We're a different breed, I think. No one can tell us no. No one can put anything in our path too great to achieve our goals. No one can tell us we can't love our job and love our child. No one can tell us we can't do it without certain features of our home life lined up. We can do it.

It's hard every day. That I won't deny. It's hard being away from my best friend and confidante; the person I want to vent to and hug and go on dates with and share in our son's new milestones and that he finally says "Mama." It's hard being a "single" parent. It's hard knowing my son is not with his mom or his dad 24-7. It's hard when your child reaches for their grandmother for comfort when they fall and you are both standing there. And oh yeah- it's hard being a surgical intern, period.

But I'm blessed. We're blessed. Training looks different for everyone (we went to a school where our basic sciences were in the Caribbean; more on that another day). Life looks different for everyone. Just because it's different doesn't make it wrong or weird or not doable. We've learned a lot along the way, and talk about it a lot (when our shifts don't overlap, that is). I'll sum it up for you, in case it would help anyone else along the way . . .

1. Don't be too proud to apply to different locations if you're couple's matching. You'd rather be a doctor in a different geographical location than not-a-doctor in the same location.

2. Surgical preliminary spots aren't as easy to get into as you might think. I think that's the going rate for almost any residency these days.

3. There's lots of spots outside the match that you don't hear about unless you look for them in the right places. Look on your specialty's program director website (a good place to start) to see if there are open positions outside the match.

4. Don't panic if things don't go how you saw them. Where there's a will, there's a way. Don't let anyone tell you something isn't possible.

5. Family comes first, but deciding to be apart doesn't mean they don't still come first. Don't feel bad for choosing it. It doesn't mean you ranked them of less importance. It just means your story looks different.

6. Speaking of stories: Life looks different for everyone. You can use yucky situations for learning and growing, or for being miserable. It's a choice.

7. When you rank programs, go where you love. The rest will fall into place.

Of note- at the time of publication of this blog, my husband has an interview for an open PGY1 EM position that came available in late July right down the street at a phenomenal academic center.

Either way, we know what we've learned through all this.

Either way, we're good.

What obstacles have you overcome to achieve success? Do you have any words of advice for surgeons or aspiring surgeons who are going through a difficult time? Please share your thoughts in the comments below.

~~~

Brittany Bankhead-Kendall, M.D, M.Sc. is a PGY1 general surgery resident at Methodist Dallas Medical Center. She obtained her M.D. from Ross University School of Medicine, M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She enjoys being a surgical intern and mentoring medical students. In her personal time she enjoys spending time with her husband and son, interior design, international travel, and Texas Aggie football.