Wearing his long, white lab coat — a symbol of his transition from doctor-in-training to clinician — Raymond Young sat anxiously in a crowded auditorium on Howard University’s campus in Northwest Washington, clutching a standard white envelope.
Like tens of thousands of other medical students across the country, Young had waited years for this third Thursday in March when he could rip open this envelope and learn where he would begin his medical career.
It marked the end of a year-long rite of passage known to med students as “the Match,” which combines elements of the college application process, online dating and the draft.
During their last year of training, almost 38,000 medical students apply to academic hospitals that offer about 26,000 residency positions.
In the fall and winter — if their applications survive the initial screening — students interview with residency program staff. Even if a candidate and a hospital like each other, they’re not allowed to commit to a residency agreement. That would violate the rules of the National Resident Matching Program, the nonprofit that has overseen the process since 1952.
Instead, the students and the hospitals submit ranked lists of their respective favorites to the NRMP in February, and the matchmaking begins. A computerized algorithm analyzes the lists, marrying future doctors to residency programs based on everyone’s preferences.
Many students will not get their first choice: There may be thousands of spots for graduates who want to go into internal medicine, with its long hours and relatively low pay, but only hundreds of spots for attractive specialties such as anesthesiology, dermatology, opthalmology and radiology.
On the third Monday of March, students get an e-mail message telling them if they have matched with one of their listed programs. They have to wait until Thursday to know exactly where they will spend the next three to five years.
About 94 percent of applicants match somewhere. (And once the computer makes a match, there is no backing out: The applicant must accept that residency or get none at all.) Those who don’t can enter something called the Scramble. Between Monday and Thursday, scrambling students can contact every program with an unfilled position until they match. Others try again next year or pursue other professions.
Young, 34, was confident he would match somewhere, given his interest in internal medicine, but he was still nervous. He has a wife and three children, and he wanted to stay close to home.
“I had to think strategically in that wherever I go, me and my family will be okay,” he said.
Young grew up in Southeast Washington believing he would graduate from Eastern Senior High School and become a professional football player. Instead, he came home after one year of college and worked part time at Hechinger, the now-defunct chain of home improvement stores.
His mom helped him get a job in physical therapy, which introduced Young to patient care. When Young eventually earned his bachelor’s degree and started work as a physician assistant, he decided to give medicine a try.
Young wants to practice in an urban environment, working with a diverse patient population.
“I can relate to those who have to decide whether they should pay for their medications or pay their light bill,” Young said. “I have a responsibility to commit my time and my efforts to those that are less fortunate, those that don’t think they can be more than what they are.”
As Young prepared to learn his destiny, Kevin Handy, 27, was across town at Georgetown University’s medical school opening a similar envelope.
Handy had known he would be a doctor since high school, when he started volunteering at Holy Cross Hospital in Silver Spring. Even when he did not get into medical school after graduating from University of Maryland, he knew he would be a doctor.
“I knew this is what I wanted to do, and I knew I could do well, I just had to find some other way to do it,” said Handy, who enrolled at Georgetown after earning a master’s degree.
Handy excelled in medical school. He earned academic honors, volunteered, researched and coached intramural sports teams.
Handy interviewed at some prestigious medical centers — Harvard, Stanford, University of California at San Francisco — for a coveted anesthesiology residency.
“You hope that everything you’ve done up to this point gives you the option to choose what you want to do and where you want to do it,” Handy said.
And on Thursday shortly after noon both men opened their envelopes.
Handy discovered he would start his anesthesiology career at his top choice, Brigham and Women’s Hospital in Boston.
And Young’s eyes teared up as he read his Match Day letter: He will begin practicing internal medicine at Johns Hopkins Hospital in June.