April 10, 2023
After months of applications, interviews, and reviewing your rank list, Match Day has arrived, and you finally know where you will be spending the next several years of your life. You’ve agonized over every detail of “the match,” and you are left with one final question: Now what?
First and foremost, congratulations and welcome to the House of Surgery. We are thrilled that you have decided to join our ranks and devote your life to the service of others. You have put in years of hard work, dedication, and sacrifice to reach this point in your career—and that deserves recognition.
In the hustle and bustle of post-match, take a moment to enjoy your success. Celebrate with your friends, family, and loved ones who have supported you along this journey. Be sure to reach out to your mentors and advisors and let them know about your accomplishment. After investing in your development, there likely is nothing more satisfying to your mentor than to learn about your successful match.
Regardless of where on your rank list you matched, be proud and begin looking forward to the start of a rewarding and fulfilling career.
On Match Day 2015, Dr. Julia Coleman (back, left) joins a group of fellow University of Toledo College of Medicine students, who met while doing medical mission work, to celebrate being matched into various programs across the US.
Everyone has a different story after matching. For Julia R. Coleman, MD, MPH, who matched into the general surgery residency program at the University of Colorado in Aurora, it was a day of celebration.
“Months before Match Day, my husband and I planned a weeks-long trip overseas in an RV, knowing this would be one of the last times in our lives that we would have an open block of time to spend together,” recalled Dr. Coleman, currently a surgical critical care fellow at The Ohio State University College of Medicine in Columbus. “I opened my match envelope with my husband, and after calling family, we packed our bags and spent several weeks in Italy. That trip is still one of our most treasured memories as a couple. Your celebration may not include a trip, but make sure to dedicate time to your closest family, friends, and supporters.”
Peter Kanuika, MD, who was an international medical school graduate, remembered a different experience. He did not have the deepest of rank lists, and while he hoped for a categorical position at a program that his medical school—St. George’s University School of Medicine in Grenada, West Indies—had historically matched students into, he knew not matching or obtaining a preliminary position was a possibility.
Match Monday came, and he matched into a preliminary position.
“I was happy to have a job, but my stomach fell out from beneath me knowing the road I had ahead of me,” said Dr. Kanuika, who is a fourth-year resident at MetroHealth in Cleveland, OH. “When the time came to learn the name of my program, I again was happy to have a destination, but unsure of what would come next. The only thing to do was figure out how to succeed, work hard, and keep moving forward. That’s what I did.”
More often than not, your future program director will send you an email on Match Day congratulating you and welcoming you to your new surgical home. Match Day is a celebration not just for the applicants, but also for programs, their residents, and the faculty who are eager to welcome new members to their surgical family.
After the inevitable email chain of congratulations and welcomes is received, it is appropriate to send a note of thanks to your program director and express your excitement about joining the program.
At this time, you likely will be introduced to your program coordinator who will be your main contact during the coming months. It’s important to reach out and introduce yourself via email and confirm your preferred contact information. Many programs have your medical school email address listed as your primary method of contact. Depending on your institution, you may lose access to this account upon graduation.
It is critical that your program coordinator has updated contact information to send you the multitude of administrative documents required for a residency program. Over the coming weeks, you will receive several emails regarding institutional paperwork and medical licensure. Be sure to watch out for these emails and respond to them quickly.
State and institutional credentialing can take a long time and often requires formal background checks that can slow down the process even more. Staying on top of these administrative tasks sets you up for success and can help avoid a delayed start date.
You also should make note of any clinical requirements your program may have such as completing online training modules or passing Step 2 of the United States Medical Licensing Examination. These tasks can similarly take significant time or preparation, and you should not wait until the last minute.
If you are a non-US medical school graduate, it is imperative that you start working on visa paperwork as soon as possible and that you are diligent in following up with the approving bodies. Kaitlin A. Ritter, MD, noted that every year during her training at the Cleveland Clinic in Ohio, one or two of the preliminary residents would start residency late due to visa or travel issues.
In addition to all the other credentialing paperwork (which can take even longer to verify internationally), visas are subject to very strict approval processes. Even small errors can set your timeline back significantly.
While a delayed start is not the end of the world—as most programs will usually hold your position (within a reasonable timeframe)—it is not how you want to start off your residency.
In addition to helping coordinate the administrative tasks associated with starting residency, your program often can help connect you with resources related to moving and put you in contact with your future co-interns and senior residents.
Reaching out to other trainees can provide a firsthand experience with learned tips and tricks for relocating. After matching, many medical students will start a group chat on a platform like WhatsApp or a group text where they can start getting to know one another and brainstorm ideas related to onboarding and moving. Your intern class will become some of your closest colleagues and lifelong friends—don’t hesitate to reach out early and start building fellowship.
As you have advanced through the various stages of your academic career, many of you have experienced several moves. And while moving is always a process, moving for residency presents many unique challenges that can be overcome by early planning and preparation.
The first item on the agenda is to find a place to live. Depending on where you matched, this can be as simple as staying at your current residence versus locating a home on the other side of the country. Important considerations for selecting a place to live include proximity to the hospital, safety of the neighborhood, access to parking and/or public transportation, and cost of housing.
Location is one of the most important variables to consider with housing. Proximity to the hospital can have significant effects on your daily schedule and experience taking home call. While living adjacent to the hospital may seem like an ideal situation, it is important to understand the amount of time you will spend at any given location.
Many residency programs have several affiliated hospitals and send their trainees for rotations of various lengths around the city or state. Choosing housing that straddles the distance between your major sites may be a more appealing option depending on your given rotation structure. To help guide your search, ask the senior residents about where members of the program live, especially since many graduating chiefs from your program may be interested in selling, subleasing, or transferring a rental to an incoming intern.
Cost of living also can be a significant consideration. Trainees’ salaries are modest, and this can result in tight budgets—especially in more expensive cities with skyrocketing housing costs. Many institutions have started offering housing stipends or hospital-affiliated subsidized housing to trainees. Check with your residency program to see if these options are available.
In addition to the challenges of finding a physical location to live in, moving also entails uprooting multiple elements of your life, such as locating child/pet care, researching school districts, and seeking employment for your spouse or significant other. While 3 months may seem like a long time, organizing these additional details can make those months fly by.
It also is helpful to consider housing location based on your partner’s and family’s needs. While living close to the hospital and minimizing your personal commute is ideal, it might make more sense to choose a location based your partner’s work. These decisions merit thoughtful discussion.
Not only may you have specific considerations for your partner, but you also may be moving or expecting a family. Ask your program coordinator about current residents who have children and reach out to them to inquire about local daycare options or reliable, safe networks to find nannies, as well as recommendations on the best school districts.
Many hospitals have an affiliated daycare with hours that are more amenable to surgery residents’ schedules. It’s possible that any of these options may have a prolonged wait time, so arranging this should be a top priority after matching (this is still the case if you are expecting a child in the near future).
One of the most exciting parts of starting surgery residency is the prospect of finally receiving a paycheck for those long hours spent in the hospital. For many of you, this may be your first “real paycheck.” And while the actual number on that check is a far cry from your future earning potential, now is an important time to take stock of your current financial situation.
Most medical school graduates matriculate with some degree of debt in the form of student loans. Depending on the type of loans you borrowed, your repayment period may begin the day you graduate. Understanding your finances, debts, and income is critically important as you embark on this new phase of your life.
The ACS Resident and Associate Society (RAS) Education Committee has published several primers on financial literacy that can help guide you through this process and can be accessed at facs.org/financial-literacy.
As part of the onboarding, your new residency program should provide you with a financial packet that outlines reimbursements, including salary, 401k/403b matching, and insurance benefits. Carefully review this paperwork as your institution may offer various programs that you can opt in/out of and can have significant financial implications.
In addition to your institutional resources, refer to the Membership Benefits page on the ACS website for information on a variety of financial benefits such as life and disability insurance, financial planning tools, and travel discounts.
The 3 months between Match Day and residency can be a busy and stressful time for students. In addition to the administrative, logistic, and life tasks required to coordinate the beginning of residency, there also may be some nagging worry in the back of your mind about the upcoming clinical demands. Seek out early training experiences if they are available.
Many medical schools offer surgical boot camps that provide high-yield didactic lectures, hands-on simulation, and shadowing experiences to help incoming interns learn key content and set them up for success. If your school or hospital does not offer a boot camp, you still can use this time to practice technical skills—such as suturing and knot tying—on your own.
One of the largest hurdles for new interns is adjusting to processes related to the electronic health record (EHR). Depending on where you went to medical school, your experience with the EHR may vary dramatically from what you encounter on your first day of residency. Even if you are using the same EHR, each hospital system has different versions of the same basic construct.
As a medical student, you often are limited with what you can do within the medical record. If you did not have the opportunity to work with your future EHR at your medical school, it can be beneficial to sit down with residents to watch and learn their workflow. How do they have their tabs set up? Do they have shortcuts or dot phrases to save time?
While you won’t be able to set up your own EHR preferences until you arrive at your program, learning the workflow and any salient tips can help improve your efficiency for when you get started.
Being a preliminary surgery resident is a distinct challenge if your intention is to remain a surgery resident the following year. In addition to all the considerations outlined in this article, you have fewer than 3 months to learn how to be an intern, impress your senior residents and faculty, acquire new letters of recommendation, and re-enter the match.
You need to hit the ground running, and preparation is key. Consider reaching out to previous preliminary residents at your program who matched and ask for their advice and guidance. Try to identify mentors early. When you find out your schedule, start preparing for your upcoming services by reading about the content matter. Your goal is to impress the faculty and program director; to achieve that, you must work hard, prepare, and get a little lucky.
Perhaps the single most important thing you can do prior to starting residency is to find your community. Surgery residency can be an intense 5–7 years with numerous trials and successes. The importance of a support team, family, and friends to help you through challenges and celebrate your wins cannot be overstated.
Your co-interns and senior residents often will naturally become part of this support system, but the value of members outside of your program is just as important. A great place to start can be the RAS, a national resident-led organization with a variety of programming, outreach, and educational arms designed to support trainees throughout their residency.
As the largest surgical resident organization in the country, RAS has a preponderance of resources to help you excel as an intern. Membership in RAS is automatic when you become an ACS Resident Member; there are no annual dues for Resident Members. More information is available at facs.org/ras.
While there are myriad considerations related to this big transition in your life from medical school to residency, don’t forget to pause and enjoy this moment.
You finally are starting surgical training, and while rigorous, residency is an important, exciting time with rapid professional and personal development. Take time to celebrate and acknowledge your community, while also preparing and planning for your near future.
If you want to hear more perspectives, check out the “Dear Intern” series, where RAS members from all over the world reflect on and share advice about embarking on this next chapter: facs.org/dear-intern.
Dr. Kaitlin Ritter is a trauma, critical care, and acute care surgeon at MetroHealth and an assistant professor at Case Western Reserve University School of Medicine, both in Cleveland, OH.
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