My favorite online resource, Wikipedia, calls gambling, “wagering of money or something of value (referred to as “the stakes”) on an event with an uncertain outcome with the primary intent of winning additional money and/or material goods. Gambling thus requires three elements be present: consideration, chance and prize.”[1] It’s a funny quirk of medical student life that we all involve ourselves in gambling during our final year. The National Residency Matching Program (NRMP) can certainly fit the definition above. The med student wagers their future (“something of value”) on the Match (“an event with an uncertain outcome”) with the goal of finding the program that best suits them (“with the primary intent of winning”). The risk involved is certainly a calculated risk, as the give-and-take of applying, interviewing, and ranking allows us the opportunity to influence the outcome, but it is a risk nonetheless. In fact, it’s worth noting that much of the NRMP data was analyzed by Anna-Maria Barry Jester on the FiveThirtyEight blog last year. The major takeaway of her work was that while the system may very slightly favor the student, at the end of the day, it is the Match’s algorithm that decides.[2]
Fourth year med students are now receiving their “prizes” after going through the “consideration” and “chance” phases of the Match. As a 3rd year med student, I’m firmly rooted in the consideration phase. I’ve already decided my future specialty (family medicine), which is more than some can comfortably say, but now I have 500 programs to sort through, and how can anyone possibly decide where to apply? The consideration phase of my gamble on the Match is just as much of a lottery as anything. Sure, I get to make the final choices, but if there is a perfect program, how do I know it’s not the one I left off my list? It’s a familiar process at least, since it is similar to applying to medical school in the first place. I sent my applications out nationwide, to both osteopathic and allopathic schools. While the system didn’t rely upon an algorithm to decide, the stakes were nearly as high, with just as much uncertainty.
The process of sifting through residencies, though, is better left for another day. Currently, I just stand back and watch as my older brothers and sisters plan their futures. I’m both envious and wary. Certainly it would be nice to know, to have a clear objective. There is a lot of security in certainty. Then again, there is a reason the casinos are always so full in Las Vegas. People love the allure of any game of chance. When the dice are rolled, in that brief moment before the outcome is known, everyone has the potential to be a winner. No one puts a program as number one on their rank list hoping they aren’t selected to go there, just as no one places a bet on number 17 in roulette hoping the ball lands elsewhere.
I’m looking forward to the Match next year. I like to play the odds, always hoping that my number comes up. Luckily, while I may have no say in what cards are dealt in poker, I do have a say in how the Match ends. I get to meet with programs and all the people who populate them. I get to talk about my passions and plans and hope they get a feel for who I am on those interview days. And when I place my rank list, whatever choices I make, I hope I’ve done enough to pick a place that wants me just as much. When the Match algorithm runs, churning out the yes’s and no’s, I hope my number comes up.
Featured image:
Gambling by Alan Cleaver