After medical school, which is four years long, the graduate must attend a residency training program in the field of their choice. These can vary from 3-8 years depending on the specialty and location. This is the case for all medical grads, not only military students. In Mike's case, he will need to complete a 4 year residency to become a fully trained and licensed anesthesiologist. At the time Mike graduates in May, he will be an M.D., but he still won't be fully licensed to practice. Residency is part of the training, and the doctor arguably learns most of what they will know as a practitioner during this time.
The process by which a student applies and is accepted to a residency training program is called "the match." The student fills out an online standardized application, and then selects the programs they want to apply to from a list . They pay a fee, and the applications are sent. The programs who are interested in interviewing that student contact them, and the student gets themself out to the program to have an interview. Then the student makes a ranked list of the programs they interviewed at in their order of preference. The programs do the same for all the students they interviewed. All this data goes into a computer that uses a fancy algorithm to produce the final result: the match. Match day is in mid-march every year, and everyone finds out on the same day at the same time what residency programs they have matched to. Once you match, that is it-- that is where you are going. This is how it works in the civilian world. In the military, it is pretty similar but there are a few differences.
There are only a handful of residency training locations in the army, and not every specialty trains at all the locations. So, in our case, there are two Army hospitals that have residency programs for Anesthesia (BAMC in san antonio, and WRAMC in Wash. DC). The application process is pretty much identical to the civilian one. The main difference being that you don't wait for a program to express interest in you to interview. You just go straight to the interview, which can be done in person if you are already there on a rotation, or over the phone. After the interviewing is all done, the program chiefs all meet together within their specialties and come up with their "merit lists." The students are awarded "points" for various things on their applications. Grades, board scores, publications, past military experience, personal qualities... all these things are awarded points. Those with the highest number of points will receive their preference of positions first. Again, a computer finalizes everything with a fancy algorithm, and the final results are sent to the Surgeon General to finalize and certify. Then, on that magical match day, military students can log onto their military medicine home page and find a document that will state where they have matched.
Anesthesia is a program that has a transitional year for the first year, and the next 3 are the actual anesthesia years (A transitional year is basically another round of all the basic core things already done in the 3rd and 4th year of school, but way more responsibility). So, for us, the first year could be done at any one of 6 locations and the next 3 will be at one of two locations. Here's how it breaks down:
- Students offered a training spot in San Antonio do transitional years in either san antonio, or el paso. The selection of who goes to which is random. There are 4 students who will match to san antonio, and 3 of them will do their first year (or FYGME) in el paso.
- Students offered a training spot in Washington DC do transitional years in one of the following locations: DC, Atlanta, Tacoma, Honolulu. Again, the selection here is largely random. There are 8 students will match to DC, and I don't know the breakdown of how many train for FYGME at each location.
If you are good at math, you have already figured out that his means there are 12 spots available this year. There are well over 12 people who are applying for Army Anesthesia... (the total number of army 4th year med students this year [in the country] is something like 300) in the past the applicant-to-position ratio for anesthesia has ranged from 1.2-1.7, but we have reason to believe that this year it may be a slightly greater number of applicants. So the next question is then... What if someone doesn't match? A common myth is that the military will make you chose a different specialty, which isn't true. Here's what does happen.
Those who do not match into a full residency training contract will at the very least match into a 1-year transitional program. (All 4th year army medical students will be given a slot within the army, whether just a transitional year program, or a full continuous training contract. This is because the Army has about 30 more positions than applicants. In years past when there were more students than spots open, the army would allow people to apply for a civilian deferment, which means they could do their residency at a civilian hospital and participate in the other match like most other students do. This year, no one will be given a civilian deferment.) At the completion of that year, they will have the opportunity to apply again (they hold a few spots open in various fields to allow these people another chance to get into the field of their choice.) If they do not get in at this point, they will complete their obligation to the army as a GMO (general medical officer) who will perform essentially the same type of role as a general practitioner. At the end of their obligation (for example, ours is two years of scholarship = two years of obligation to the army), the GMO will be free to pursue civilian residency training and be done with the military, or they can opt to stay in the military if they really like being a GMO.
So, two weeks from now we'll know! I think we'll be happy wherever we wind up, and we just really really hope that he gets into a full four-year anesthesia contract from the get-go. Mike is very anxious about what the future holds for him. I personally am not, since the match process is merit-based. I pity the fools who are up against Mike in a merit-based contest! But even so, there is still an element of the unknown that goes on in this whole crazy process and we will just have to wait two more weeks until we can rest easy.
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