Medicine, residency

The Match, the Scramble, and the SOAP: Life After Choosing a Different Specialty

Match Day is the culmination of a medical student’s education: the day all graduating seniors and non-traditional applicants find out where they will spend the next three to seven years to train in a desired specialty. I fell in love with Obstetrics & Gynecology (OB/GYN) as it was the perfect way to combine my passion for women’s health with medicine and surgery. I also liked that the patients were relatively healthy and willing to heed medical advice for the betterment of their families. I applied broadly across the U.S. — 45 programs to be exact, and received a total of 30 interview offers. A few months and 13 interviews later, I anxiously awaited the results. On Monday of Match week, I was rotating in the Pediatric ICU and stepped away from rounds to open my email, ecstatic to receive the confirmation that I would soon be an OB/GYN in-training:

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I stared at the words on my iPhone screen until they became jumbled letters. This has to be a mistake. I felt the tears well up as I immediately ran to an unoccupied stairwell to call my mother. She was equally as shocked and devastated.

How could this happen? I was a U.S. graduating senior with Honors in all clinical clerkships, >250 on my Step 1 and Step 2 CK and ample extracurriculars. I spoke multiple languages, had no major red flags on my application, never took any time off, never failed a test in my life, and had excellent professional relationships with everyone I worked with. Pushing the racing thoughts aside, I went to see the Dean of Student Affairs where I met the others in my class who had not matched. To some degree, they had a feeling that this was coming for them and were surprised to see me there. We were given access to the list of unfilled programs through the Supplemental Offer and Acceptance Program — SOAP, formerly known as the Scramble — which included various specialties including Internal Medicine, Radiology, Anesthesiology, and numerous preliminary Medicine and Surgery positions. There was not a single categorical spot in OB/GYN. I was losing hope.

The Dean encouraged me to apply to other specialties so I sent applications for categorical Anesthesiology, Radiology, and preliminary positions in Medicine and OB/GYN. I did not know that preliminary OB/GYN was an option, but I was told to be wary of such offers as there was no guarantee of staying on for a categorical position. I received several phone interviews from program directors in Radiology, Anesthesiology, and one from a reputable OB/GYN program for their preliminary position. The phone calls felt very impersonal; it seemed as though their focus was to explain to me what the residency program could do for me, without any particular interest in me as an individual. One program director from an Anesthesiology program was the only one to ask how I was coping with the circumstances. She understood my heartbreak and expressed confidence that I could find fulfillment in an Obstetric Anesthesiology career. She made me feel like a person rather than a warm body to fill a residency. Nonetheless, my heart was still set on the preliminary OB/GYN position as they said they would “do their best” to help me obtain a categorical spot at a different program the following year. However, they did mention that the preliminary intern was ineligible to re-apply for a categorical spot. The only way for me to continue as a PGY-2 at that particular program was if one of their trainees left the residency. Trust me, no one was going to leave a program that reputable, so my chances may have been better at winning the lottery. It became clear to me that the sole reason for them offering a preliminary position was to ease the workload on their categorical residents.

The first round of offers came in on Wednesday morning. I anxiously waited and expected that I would have to make the decision to take a chance on a preliminary position doing what I loved, or take a chance and jump into another specialty altogether. When the time came, I refreshed the Offers page and discovered only one: a categorical position in Anesthesiology, from the only program that seemed genuinely interested in me. This is it. The preliminary OB/GYN position that I was so torn up about ended up not being an option. I felt so rejected by the specialty and everyone in it, so I took a leap of faith and accepted the offer in Anesthesiology.

It took weeks, if not months, to recover from the emotional trauma of not matching. The feeling of watching your friends and classmates see their dreams come to fruition while yours crumbled around you is earth-shattering for a medical student. You spent thousands of dollars traveling to interviews and countless hours perfecting your application, especially your personal statement; imagine having to write a new one in one hour to explain why you want to do this *other* specialty. The only specialty I had a real story for was Anesthesiology, when I witnessed a laboring woman collapse from an amniotic fluid embolism and watched the anesthesiologist and obstetricians work together to resuscitate her. I enjoyed the occasionally critical nature of OB/GYN, and recognized that an anesthesiologist was vital in these emergency situations. As a 4th year medical student originally bound for OB/GYN, I knew nothing about what was really happening on the other side of the drapes.

So what went wrong with my application? In retrospect, I ranked mostly top-tier programs in competitive cities for a specialty that offered limited positions. The smallest program size was 4 residents and the largest was 18 — compare that with the class sizes of internal medicine! It was important to me to live in a big city as I spent medical school in a relatively isolated part of the country, so that may have played a role as well. Furthermore, my home program did not rank me to match as they were aware that I did not want to stay, and also believed I would have no problem going wherever I wanted. Unfortunately, this kind of confidence is not only unrealistic, it can be disastrous. Aside from spending a year doing research and ‘making connections’, I truly felt there was nothing else I could do to improve my application. Someone once told me, your chances of getting into residency are never better than the first time you apply (especially if you are a U.S. senior). I also heard that applications from U.S. graduating seniors are in a ‘priority’ pile, while everyone else’s application is tossed into the ‘other’ pile. This may or may not be true, but hearing this heavily influenced my decision to pursue another residency.

I spent intern year in various disciplines of medicine and surgery and actually enjoyed experiencing the different specialties. However, the first six months of CA-1 year (PGY-2, Clinical Anesthesia-1) made me feel like a total imposter. I had traded in the speculum for a laryngoscope and had no idea what I was doing. I feared everyone around me felt the same way about me. Little did I know, many of my co-residents — who were always anesthesiology bound — experienced similar insecurities. As most residents come to realize, all procedures are subject to the numbers game. ‘See one, do one, teach one’ is really a thing. I remember attempting to intubate as an intern and thinking ‘I will NEVER be good at this’. I felt the same way about arterial lines, IV’s, central lines, epidurals, and nerve blocks. I mentioned in my previous post: On being a doctor: things I would tell my younger self, that there is something strange and intriguing about practice. Day by day, you feel you are not learning much at all, but as the years go by, you are capable of doing more than you ever imagined. When I expressed my insecurities to my program director, he reassured me that one day I would be able to place central lines with my eyes closed. I am almost done with residency, and my eyes are still open (but the lines go in much smoother).

I was the first in my class to rotate in Obstetric Anesthesiology, and it made me fall in love with my career once again. Childbirth is an immensely stressful experience for the body, and having the skills to alleviate that trauma gives me a great sense of fulfillment. As we now know, SOAP stands for Supplemental Offer and Acceptance Program; part of the renaming for ‘the Scramble’ was to make the process less chaotic and more streamlined. After my horrible experience, I grew to despise the words ‘match’, ‘scramble’, and ‘SOAP’. The best part of all this is that the national organization for obstetric anesthesiologists is called the Society of Obstetric Anesthesia and Perinatology, aka… SOAP! It was meant to be.

There are days when I wonder what my life would have been like if I had continued to pursue OB/GYN. Having a good friend who is an OB/GYN resident, I know it would have been a lot more work than my current average of 60-70 hours/week. Anesthesiology residency has taught me a great deal about trust, patient care, interpersonal relationships, and above all, myself. I have learned how to safely take patients through the most distressing experience of their lives and make it less traumatic. It has made me develop thick skin to not let others’ negative attitudes shape my perception of the world. It has taught me to persist in what seems to be an endless, dark tunnel. And for those things, I am grateful. I finally see the light at the end and am looking forward to continuing my passion for women’s health as an obstetric anesthesiologist.

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