Rite of Passage for Some Medical Students: “Scramble Day” Explained

UPDATED on 2/25/13: As of the 2012 match, "Scramble" no longer occurs. The NRMP instituted a much more orderly process, which I'm told worked well.

Ironically, this year the "Ides of March" marks the annual rite of passage for fourth year medical students known as “Scramble Day.” Graduating student participate in a matching program that links them to residency training positions. Throughout the fall and winter, students take electives and go on as many as 20 interview trips seeking coveted residency positions. They then submit a list to the National Residency Matching Program [NRMP] ranking the programs they want. Likewise the programs rank the students. A computer crunches the two lists and the next several years of a graduating med student’s life are revealed.

Unfortunately, some students, usually one or more from every US medical school and hundreds of students from international schools, do not “match” and today is the day they find out. Starting at noon today, they “scramble” to find residency training positions with programs that have unfilled slots.

The process is painful for both the students and the residency program directors. Unmatched students, whose predicament is usually the result of ranking programs “out of their league,” having some blemish on their record or simply being from non-US schools, have to quickly get over their embarrassment and disappointment and face the reality of scrambling to find a job for the coming academic year. Program directors [PDs] have unfilled positions either because their specialties are not in favor with graduates, their programs have problems or there are too many positions to fill.

General surgery has a unique issue in that so called “categorical” or full five-year positions are in high demand, but there are far more“ preliminary” [one-year] slots available than there are takers. These one-year positions are meant for those entering subspecialties like orthopedics or ENT. Due to the needs of the programs to staff their hospitals, there are some 400-500 preliminary slots in excess of the number of one-year positions actually needed by the subspecialties.

At noon today, phones will be ringing off the hook and fax machines will be overheating as the scramble gets underway. Residency program directors will have to decide which applicants to take based on brief telephone interviews, and the students face the same under-informed decision process. For US students, associate deans often act as agents trying to explain why their anxious student didn’t match. International students are on their own.

Many interesting deceptions take place. The records of some students, who didn’t match because they are crazy, lazy, just not too smart or all of the above, are buffed up by their deans. International students always claim to be at the top of their classes, and the information is impossible to check. Students who had their hearts set on orthopedics and didn’t match have to now say they wanted to be general surgeons all along.

It is the epitome of a “crapshoot” for both parties.

Thankfully for me, I am no longer a participant in this nightmare, but I empathize with both the PDs and the students. Good luck.