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Match, SOAP, and Suicide

Well how could I forget to talk about match? Unlike previous years, I’ve got several friends who are anxiously waiting or at least were waiting, to find out if they got matched or not. The medical system is broken and match is part of the problem, but for those who aren’t in it, you may not understand what match even is or why it’s important. In fact, if you don’t follow medical students on twitter for example, you may never even realize match was happening.

So you want to be a medical doctor. Most people want to do it because they care and want to help people. I’m sure some want the prestige that comes with a medical degree or are doing it because they feel obligated, but I sincerely hope that most do it because they long to make a difference in the world. These are probably the people most at risk for suicide, because if medical school wasn’t tough enough, then they have this time of the year to worry about.

I saw someone on twitter discribe match as a mix of applying to college and online dating and I feel like that is accurate. Keep in mind I’m on the outside looking in here, so my opinions are probably that, but I also have people I care about stuck in this hell of a system. Match comes around after you’re in your fourth year of medical school because to practice (here in the US anyway) you need to complete a residency. And that is how match was born.

For match you need to write a personal statement, for anyone who’s applied to grad school or any sort of fellowship program, yes it’s that kind of personal statement. For “convenience” medical students can apply through one central system to as many residency programs as they like. While this is not a bad thing, it helps contribute to the over-application issue. Because at the end of the day there are more medical students than there are spots. Plus this is just the start of the match horror story.

Because there are so few spots, the programs have a set number of interviews. Since an applicant wants to maximize the odds of getting accepted, they tend to apply to as many programs as they can knowing they will only hear back from a fraction of the places. Interview invites are sent via email… without warning and sign ups are on a first come first serve basis, so you need to act quickly to get a slot or you will be out of luck. Slots can fill as quickly as 10 minutes after the invite is sent, so you need to be glued to your computer or risk losing a spot.

This happens for WEEKS. So friends or family will sit by the computer waiting anxiously to hear back. Because while all this is going on the medical student has other things to do, like attend medical school. So it can (and is) a group effort. From what I’ve seen some programs give advance notice, but those are far and few between, so it takes a village to make a doctor.

So you’ve got a slot, well the next part is meeting with your potential program! This is where the dating part takes over because interviews come fast and you need to read up a bit about the program (more than you did when you applied). This year from what I hear it’s all been done via zoom. Which I think is better personally, but again outside looking in, so your mileage may vary. Once you’ve finished your interviews it’s time to play the waiting game because you don’t get to hear back right away. This is where match comes in.

You and your prospective programs each create a ranked list, and I’m not joking, about where you want to go. There are strict rules in place preventing you from asking where a program is ranking you and for the program to do the same. You may get an email saying they liked you, you may not hear back at all, it’s all a luck thing. In the end, you score them, they score you, and into the match system we go.

Early March is when the rankings are due from both the programs and the students and then you have to wait two weeks. Why two weeks? Why not? It’s fun, it builds suspense, there’s absolutely no reason for it, so fun. If you’ve heard of the match algorithm, this is where that comes into play it sorts through every ranking from both student and program and if the ranks match, then there you go! The whole process probably takes an hour to run through the algorithm if they’re doing it on a cellphone, but two weeks because you should get used to waiting for results as a doctor I guess.

Then we hit match week, hey that’s this week! Where people find out if they have matched… but where would the fun be if they gave the surprise away? You find out you matched, but not where you matched. Seriously, I wish I were joking. But because there are so many more students than spots this week is incredibly stressful because you can also get another email the one that says, you know, you did not match.

But hope there remains because some programs didn’t get enough people that matched with them (because of how the ranked system works) so now we get to SOAP. SOAP is short for Supplemental Offer and Acceptance Program, they named it SOAP because you feel dirty after this whole mess of a process (not really, but I think it had something to do with it). SOAP is similar to the match program, but you need to do it all in lighting speed. The entire SOAP process is the same thing as match, but condensed to days, so a bit stressful (incredibly stressful). Also proof that the “algorithm” doesn’t actually take two weeks to run. SOAP started Monday this week and ends today, so again, fast.

Friday of match week is when people who got matched (including SOAP) find out where they go, hey that’s tomorrow as of this writing! But you’re already committed to go, so even if it wasn’t your top pick or you think you could do better, well too bad. Once the reveal happens, you get roughly 2-3 months to pack up your life and move.

Unfortunately this week feels like make or break for some. I imagine I had a similar feeling back in undergrad when I wasn’t sure I was going to get into the program I wanted. You don’t really know what you’ll do next, you’ve planned your whole life around this one thing and suddenly you feel like you’ve failed. I’ve never had to do match, but I imagine it’s painful if you aren’t selected, which is probably why there are so many suicides around this time of the year.

In fact a lot of the time when match week roles around you get tons of doctors sending out congratulation tweets followed with suicide prevention hotline numbers. Again, if it’s one thing I understand it’s wanting to kill yourself and the feeling of failure after all that stress and work, it’s a lot. So I don’t blame anyone who feels they can’t go on. I mean you spent four years of your life accumulating a ton of debt and you worked your ass off only to feel like you’re not good enough to match. As usual no judgement from me, I don’t think I could go through the process let alone being rejected. The gameshow feeling of the whole process doesn’t help anything either.

Now, there are alternatives to match and SOAP. In fact, sometimes people opt to not even bother with SOAP at all and instead take a gap year, do research, or some other adjacent thing to help strengthen their application for the following year. So there is hope, all is not lost, and if you didn’t match, you’re certainly not the only one. There is just too many students and not enough slots, but also the system is horribly broken.

In the end, this is an incredibly stressful time for people and if you’ve matched, congratulations! It’s a good feeling to achieve something like that.

If you haven’t matched, there’s no shame in it. Sometimes failure is just a step on the way to success. Everyone deals with failure at one point or another and if you don’t fail you’re not trying hard enough. There are alternatives to suicide and remember you’re not alone in not being matched, there are so many others just like you who are just as good as anyone who got matched, just not as lucky and I do mean a lot of it is based on luck, not skill.

Don’t be afraid to reach out to friends, family, or other people who didn’t match for support. We’re all here to lift each other up and not matching isn’t a burden you have to carry alone. This isn’t the end, it’s just another small step to where you want to go.

Something I’ve learned the hard way is that, today is awful, but tomorrow will be less so. Just take it one day at a time. And if you feel like you can’t talk to friends, family, or internet supporters, there is the hotline: https://suicidepreventionlifeline.org/

Taking about it helps, trust me on that.

4 responses

  1. I had never heard anything about this. Now that I do, it does sound rather broken. If there’s anything society needs at the moment, it’s more medical staff. So really anyone who’s not unqualified ought to be getting a “slot.”

    When I was dealing with my neuropathy nonsense last year, I ended up at a residency clinic (before one of those doctors finally referred me to the neurologist). Once I called during normal business hours on a Friday and was told that there were no doctors in. Another Friday, there wasn’t even a receptionist at the desk. If they don’t have enough people to run the clinic every weekday, then what are they doing not taking more students in as residents?

    One time I read someone’s opinion (don’t remember where) that our medical system is run like a cartel. Existing members of the system have an incentive to limit the number of new members, to hold down competition and keep prices/salaries high. So they exploit the regulations or traditions that were ostensibly about promoting safety and quality, and steer the system to make it deliberately hard for new healthcare providers to enter. I’m not enough of an expert to verify whether that’s true, but it wouldn’t surprise me.

    Liked by 1 person

    March 17, 2022 at 2:00 pm

    • It’s wild because you can get a whole ass medical degree, be in literally a lifetime of debt, and NEVER match in a lot of cases so you would never be able to practice medicine in the US (well most states anyway, I think there are like 1 or 2 that give temporary conditions). This year there were ~ 11,000 people who didn’t match, last year it was “only” ~8,000 so the problem is only getting worse.

      That’s such a wild story, you have no doctors in and no one is concerned. People need care, especially now that the pandemic has strained the medical system past its breaking point, why don’t we adapt for this?!

      I wouldn’t be surprised if the cartel theory is true. The disconnect between people running the hospitals and regulating healthcare and regular people who need the care is startling at best. The whole system is falling apart and the people in charge just want to turn a profit. Healthcare should never be for profit.

      Liked by 1 person

      March 18, 2022 at 10:24 am

      • See, I had NO idea. I would’ve been the type to encourage more people to choose the medical profession if they had the right talent and personality for it. I didn’t realize there was this major bottleneck at the residency stage.

        A bit of quick reading not only confirmed the problem (we have both a current and projected shortage of doctors, and a severe lack of residency positions), but also showed that bills to fix this have been trying … and failing … to get through Congress for years. Just last year there was one, the “Resident Physician Shortage Reduction Act of 2021,” which would have funded 2,000 new residency positions every year, and it doesn’t look like it passed.

        At least that explains to me why clinics don’t just take more students. I didn’t realize residency programs were treated as a cost to hospitals and federally subsidized – so getting more means convincing the government to spend money. Apparently the hospitals pay for some residency slots themselves, but they don’t want to spend the money either so that source is also limited.

        This can’t be good for the country, let alone the medical graduates who don’t make the cut. If we’re weeding people out of the medical profession after they spent the money and time to get a degree, then we’re just burning up our own talent.

        Liked by 1 person

        March 18, 2022 at 7:25 pm

      • Exactly! It’s a horrible system and it doesn’t look like it will be changing anytime soon. That’s why match week in general stresses me out, there are so many people who don’t get matched and in some cases never match. I’ve seen talk of doctors suggesting that premeds or other med school track students get counseling so they are aware they could NEVER get matched before they go that road since it isn’t common knowledge. Still, that doesn’t fix the fact that we need doctors and nurses now more than ever and no one in power seems willing to bend.

        Liked by 1 person

        March 19, 2022 at 9:22 am

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