You finished medical school. Time to get a job, right? Wrong! Finishing allopathic med school gets one an MD but does not allow one to actually practice medicine. For that you have to complete what is more or less a paid apprenticeship, termed a “residency” because it involves essentially living at the hospital for the duration. The first year of residency is known as an “internship,” in order to keep things nice and straightforward for everyone following along at home. Intern year is a trial-by-fire Immersive Learning Experience where your decisions suddenly matter; in between breakdowns you take Step 3 and collect a medical license. How many additional residency years are required after the internship depends on the specialty you are pursuing (this is the big-category stuff: family, pediatrics, internal medicine, surgery, psychiatry, and so on). After that, you can go on to do a “fellowship” where you get additional training in a particular subspecialty (this is the specific stuff: cardiology, endocrinology, colorectal surgery, child psychiatry, and so on).
For my video gaming friends, it’s a tech tree, where the points you spend to level up are earned by trading years of your life. Once you’ve knocked out a bunch of the low-level skills you unlock class selection (mage, warrior, etc.). Once you’ve committed to a class you then have additional options to further adjust the class to your playstyle (berserker, battlemage, 1H vs 2H weapons, etc.).
Okay, back to the whole “getting a job” thing. You need an internship to take the last test to get a license, the internship comes bundled with a residency in some medical specialty, the residency unlocks the possibility of a fellowship. Getting a residency involves picking a specialty, filling out a centralized application, paying to send it to a bunch of places, waiting for those places to invite you to interview, and going on a bunch of interviews. Here is where a reasonable person might expect job offers to arrive, but no! That is not what happens.
Instead of simply getting a job offer, there is a process known as
OkCupid “The Match” where all the applicants in a specialty create a list ranking the residency programs where they interviewed, and all those places create a list ranking the applicants. In March, some people press “go” on a legally-binding algorithm that attempts to connect all the applicants to a residency spot. Hopefully one of your top places also thinks you’re a top applicant so you get lucky have a place to work come July 1st.
Are there enough spaces in the medical specialties for everyone who wants one? No, no there are not. As a result it is possible to fail to match, in which case you win the right to participate in The Scramble, rebranded by People Who Are Not Medical Students as the “Supplemental Offers and Acceptance Program (SOAP).” This involves spending the next several days frantically applying to everywhere you can think of in the hopes of getting an open residency spot in your specialty of choice at some place that also didn’t match a student, or failing that, an open spot for any specialty anywhere.
Finally, at the end of the week, The Match sends out an email telling the people who did match exactly where they matched. After that we all go back to our regularly scheduled rotations because it’s still March and there are several months of school remaining, only now we also can fret about moving to wherever. At some point after graduation, the no-longer-students take their shiny new (but useless) MDs to the residency program, where on July 1st they become interns and realize they know absolutely nothing…but that’s another story.