On March 15, Hilda Watkins walked on stage in front of her classmates, pushed a thumbtack into a large map of the United States near Chattanooga, Tennessee and took her latest step toward fulfilling a lifelong dream of becoming a licensed physician.
Four years of hard work, late nights and sacrifices had paid off. Match Day was here.
“I can remember so many days when I would go to class all morning and then spend the rest of the day in the library,” Watkins told Lagniappe. “Just knowing that everything you’ve worked for the past four years is coming to fruition it’s … it’s just amazing.”
A senior at the University of South Alabama College of Medicine, Watkins made those comments just minutes after learning she’d been accepted into a residency training program for emergency medicine at the University of Tennessee College of Medicine Chattanooga.
In their fourth year of medical school, seniors decide what they want to specialize in and begin to seek out teaching hospitals that offer residencies in that particular area of medicine. A residency is essentially on-the-job training for new doctors after they graduate.
While graduation, white coat ceremonies and other milestones are important on the journey to becoming a doctor, Match Day — the third Friday in March — is one of the most impactful. The program students match with can alter career trajectories and uproot lives in a few seconds.
Watkins was one of 77 USA medical students and more than 35,000 across the country who learned where they would be going to continue their education last Friday. At 11 a.m., students throughout the U.S. and in Canada, opened envelopes showing where they had matched.
John Marymont, Dean of USA’s College of Medicine, found out where he’d be doing his residency 33 years ago the exact same way. Before this year’s results were released, he told an anxious class of 2019 to “embrace what’s in [their] envelope,” regardless of where it takes them.
“This is a hugely important day for all medical students,” Marymont said. “A doctorate of medicine is four years of very time consuming and difficult work, and this now allows them to start specializing in the career they want. Thirty-three years ago, we didn’t have all the pomp and circumstance they do know, but the calling into medicine was still the same.”
When asked what made her want to go into medicine, Watkins traced her dream of becoming a doctor back to the early ‘90s television hit “Rescue 911.” She said that show and a volunteer program she participated in during high school sparked her interest.
Before the big reveal, Watkins’ mother, Evelyn Watkins, said she didn’t care where Hilda matched “as long as she’s happy.” After seeing Watkins open her envelope at the table with her fiancé and family to cheers and hugs, it would be hard to argue she wasn’t happy.
“It’s been a lifelong dream of hers. Even when she was a little girl, she’d say: ‘I’m going to be a doctor,’” Evelyn said. “As the Bible says, ‘write it down, and make it plain.’ She wrote it down and today we’ll get to see it come to fruition.”
The matching process for medical residencies is overseen by the National Resident Matching Program. Students rank a list of prefered residencies, medical institutions rank a list of desired candidates and NRMP uses a mathematical algorithm to pair them together.
Landing a residency, especially one in more specialized areas of medicine, is an extraordinarily competitive process. For those seeking a career in neurosurgery, ophthalmology, dermatology, orthopedic surgery and other specialties, even getting an interview is an accomplishment.
This year, 44,603 students applied for just over 35,000 positions. Those who don’t match can possibly shift their focus to an area of medicine that still has residencies available, but there are usually very few of those, if any. The only other option is to try again the following year.
Students find out whether they matched at all the Monday before match day, but have to sweat out the next four days wondering where. Residencies last three to seven years, so that can mean the difference between renewing a lease or planning a cross-country move in a few months.
Things can be even more complicated for students who are married or have families.
Anna Teachy said her husband, Will Teachy, matched with an orthopedic surgery program this year, and location factored into how he ranked programs. She works at Haint Blue Brewing Company and they live in Mobile, so a match at one of USA’s hospitals would have been ideal.
Will wound up matching with Wright State University Boonshoft School of Medicine in Ohio, but Anna said they were happy he matched anywhere.
“That’s the thing with being in medical school. The third Friday in March … you always know this is a day that’s going to come,” Anna said before the Match Day ceremony. “Orthopedics has been super competitive this year, and we’re just thankful he matched somewhere.”
Throughout the U.S., the number of orthopedic applicants was nearly twice that of the available residencies, and Will Teachy was one of only three members of his class who matched with an orthopedic surgery program at all.
About 15 percent of the Class of 2019 matched with programs at USA hospitals in Mobile. However, only one student matched for an orthopaedic surgery residency at USA — a program that only accepts three first-year post graduates a year. That student was Joseph Anderson.
A Mobile native and Faith Academy graduate, Anderson opened his envelope with his wife, three daughters, mother, father, two brothers and younger sister standing by. When they found out he’d be staying in Mobile, the reactions ranged from tears to jubilation.
“Being married and having kids, it’s just a huge bonus for us to have family here,” Anderson said. “I know they would have supported us anywhere we wound up, but my family was definitely thrilled we’d be staying. I’ve got two brothers and a younger sister — they’re all here.”
Anderson said he already had to spend three months away from his family last fall visiting medical programs throughout the Southeast trying to get interviews with residency programs. During the ceremony, Anderson said he wanted his family with him on Match Day because, even though he was the one in medical school, they’ve all gone through it together.
“[My daughters] are there when I’m studying in the evenings. That’s all they’ve ever known is dad being in medical school,” Anderson said. “It’s been really special to share this with them and with my wife. We’ve been together since high school, and she’s followed me through all of this.”
Is there a doctor in the house?
According to Marymont, there were some students in the class of 2019 that matched with specialized programs that are often very difficult to get into.
John Roveda Jr. was one of two students in the country accepted into a radiation oncology residency at the University of Alabama at Birmingham this year, and the neurological surgery program Ryan Screven matched with at the University of South Florida was just as selective.
Many USA students the 2019 class matched with residencies related to some type of primary care, which includes specialties like internal medicine, pediatrics and others. Marymont said many of those future doctors could play a very important role in the lives of Alabamians.
As a state-sponsored school, he said part of USA’s mission is to produce quality physicians to serve the people of Alabama.
This year, 25 percent of the seniors placed in residencies will be learning at teaching hospitals in Alabama. Marymont also said USA ranks in the 80th percentile of all medical colleges when it comes to students returning to the state to practice medicine after their residency.
He also noted the class of 2019 included one of the first USA students to participate in a Blue Cross and Blue Shield of Alabama program intended to bring doctors into rural communities.
Last year, BCBS launched a program that pays for the last two years of medical school for students who commit to providing primary care in an underserved area of the state for three years. Perrin Windham was one of three students to receive a $60,000 scholarship from BCBS.
Friday, Windham found out she matched with a pediatrics program at University of Tennessee College of Medicine in Chattanooga. Previously, BCBS has said it plans to put $1.2 million toward scholarships for other USA medical students over the next four years.
Marymont said USA has been fortunate to see so many of its students match with residency programs. However, he said a long-time federal cap on funding for residencies has caused teaching hospitals to take on additional costs when training residents, while also limiting the expansion of existing training programs and the number of trainees they can accept.
“There are now more graduating medical students in the country than there are residency slots, and this has just happened within the last five years,” Marymont said. “That’s unfortunate because there’s a physician shortage now, there will be a physician shortage in the future and that comes down to federal funding. We spend millions of dollars outside of those federal caps to train our residents, which means we have to earn money to train these physicians for the state.”
Residents are paid by the hospitals they work for, and there are a number of additional costs incurred by the program outside of those salaries as well. Since the 1960s, hospitals have been reimbursed for some of those expenses through Medicare and Medicaid.
According to the Association of American Medical Colleges, the U.S. government invested close to $15 billion in graduate medical education in 2015. However, the number of positions government will fund has been capped at 1996 levels for the last 23 years. Recently, some in the medical community have advocated lifting those to help address a growing shortage of doctors.
Last week, U.S. Rep. Terri Sewell, a Democrat representing Alabama’s 7th Congressional District, introduced a piece of bipartisan legislation aiming to do just that.
As written, the Resident Physician Shortage Reduction Act of 2019 would increase the number of Medicare-reimbursed residency slots nationally by 3,000 each year from 2021 through 2025, for a total of 15,000 slots. According to an estimate from the AAMC, funding 15,000 additional residencies over a five-year period could cost Medicare $9 billion over the next decade.
Though a similar bill failed to pass in the Senate in 2017, Sewell said she co-sponsored the RSRA bill because she believes the U.S. needs to start training more qualified doctors immediately.
“This week, medical students across the country will celebrate their match into physician residency programs, but many of their peers will be left without a residency due to the gap between students applying and the number of funded positions. At the same time, the United States faces a projected shortage of up to 120,000 physicians by 2030,” Sewell said in a statement last Thursday. “Increasing the number of Medicare-supported residency positions means increasing the number of trained doctors to meet growing demand. It also means giving hospitals and health centers the tools they need to increase access, lower wait times for patients and create a pipeline of qualified medical professionals to serve Americans’ health needs.”
The bill has yet to make any significant moves in the House, though a companion bill has also been filed in the U.S. Senate. The plan has also been endorsed by the AAMC as well as UAB Health System CEO Will Ferniany. Marymont didn’t comment on the bill directly, though he echoed the concerns that leaders at other medical colleges have raised about the 1996 caps.
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