Distant Imaginings

So, if you know me (and I'm assuming everyone who reads this, does), you know that I'm a planner. A big time planner. I pretty much enjoy knowing what's going to happen in my life months if not years in advance. It's one of my qualities that my husband loves most about me (::insert sarcasm::).

One of the most daunting problems of medical school for a planner like myself is...(dun dun duuunnnnnn) The Match. The Match, for those lucky enough to be uninitiated in this sadistic ritual, is the way that we med students apply for, interview for, and discover where we will spend our residency years. Basically, you apply for whatever programs you think you might be interested in, interview at the places that like you enough to extend the offer, and then create a list of your favorites, in order. The tricky part is, the residency programs also create a list of their favorite interviewees, in order. So, let's say that my number one choice for residency is Program X, number two choice is Program Y, and number three choice is Program Z (and so on ad infinitum). Let's suppose that Program X has 25 slots available, and they rank me in their 5th slot (which means there were 4 people they liked more than me--impossible to imagine, I know). A fancy computer somewhere in the ether says to itself, "B likes Program X and they ranked her as well, so she gets a tentative spot at Program X. Now, Susie Q over here also ranked X as her number one choice, but they ranked her higher than B so she gets a slot above B." This continues so on and so forth. If a program has 25 spots and ranked me 26th, and the 25 people they ranked ahead of me all rank that program number one, then I get bumped to my 2nd choice, etc. This continues until all spots are filled. The big Catch is the fact that wherever you get "matched," no matter how far down your list you went, is where you are contractually bound to spend your residency.

The biggest issue with this system is the fact that, until Match Day (the day that every single 4th year medical student in the country opens a little white envelope telling them their fate for the next several years), you have NO IDEA where you will go. Programs may hint at "we like you," but there are no guarantees that your number one will rank you high enough for you to match with them. Which means that until 2 months before your graduation, you can't make plans for the future.

This is an even bigger issue for people like me with spouses or significant others who are committed to going along for the ride and uprooting (or staying put) to who-knows-where for 3+ years with no real choice in the matter at the end of med school. This generally means that us attached folks try to apply to, interview at, and rank programs that are in areas where our loved ones could tolerate living, find jobs, etc. The application process for me is still about a year away, but D and I have already begun to discuss these kinds of topics so that, when the time comes, I will have a decent idea of what programs to check out and where I might want to apply. Originally, we both thought that we'd like to stay at my home program (i.e., do residency in the same town where I've been in med school), because this is essentially our home town, our families are nearby, and it's a nice area in general. This is still quite the possibility, but more recently we've begun exploring other options, mainly because D's job prospects in this area are not the best. Not that he doesn't have a job, or couldn't find a better job, but his dream job exists most decidedly Elsewhere. It seems to exist, in fact, in the vicinity of Washington, DC. And, knowing how much D has sacrificed for me to become a doctor, wouldn't it make sense for our next big step to take him into more consideration?

There is a residency program in DC (for the field that I think I might like to pursue) that seems wonderful. They have a lot of really interesting options not seen other places, international electives that I would seriously enjoy (and can't find at other programs), pays more than any residency I've ever heard of, and it's highly praised in a lot of areas. Obviously, I am intrigued. But with intrigue comes also worry, for a planner like me. As much as I ponder how interesting it could be to learn medicine at this program, how exciting to spend weekends at the Smithsonian or Lincoln Memorial, how convenient to live within drivable distances of beaches, mountains, and big cities all at once, I also start thinking about logistics and worrying over the small possibilities. How would we afford to live there? Our home now is somewhat small but lovely, with a big yard and nice neighbors and a school down the street. Were we to move to the DC area, we might be able to afford a condo but certainly not a house--where will the dog play? What if the bills are too much? Traffic is supposed to be horrendous, how will I manage coming home from a 24 hour call shift if the commute takes an hour at rush hour? Most importantly, how will we get along without our support system? Our families are here, our best friends are here--when you're tired and bored and unsure of yourself, there's just nothing that beats being able to drive a few minutes to have dinner with your best friend or hang out with your mom. It's a scary thought, being 10+ hours away from our cozy midwestern roots.

Obviously, this is all distant, and simply theoretical. But my brain likes to play with the possibilities, because that's the only way I can plan. And planning, well, that's just what I do.