Fellowship matching

[kjj17]

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As an M1 I am thinking wayyyy ahead here, but as a married & somewhat older student who is hoping to start a family in the near future, I am curious to hear some perspectives

My husband is entering med school next year so he is a year behind me. We will either couples match, or I will be a year ahead and he will try to match me geographically (we're hoping to be in NY anyway, somewhere with a lot of options). The dean at my school recommends staggering it, saying that my being somewhere already provides far better leverage, and couples matching is so risky.

My question is for fellowships... we are each interested in fields that require one (I KNOW it is early and we could well end up changing our minds, but better to begin understanding the process just in case)... what is the process like for married couples matching into a fellowship at the same time? Would this also be a situation in which it may be better to stagger by a year (me one year ahead, he follows me)?

It just makes me anxious if I'm always a year ahead, because if we end up having children in the next few years as is our hope, that would obviously complicate things--if it was just the two of us we could spend a year long distance, but probably not a good idea if kids are involved.

Please be kind... I've seen some animosity in threads about balancing family/motherhood and medicine lol. We are living near family and will be able to afford some help, so childcare isn't as big of an issue as keeping the family together geographically

Thanks!!

Edit: In case my concerns seem unclear, see bolded last sentence. I want to hear perspectives on how hard/easy it is to stay geographically together, especially if we have kids. Is it better to stagger or match together, for both residency and fellowship

 

[DrBowtie]

As an M1 I am thinking wayyyy ahead here, but as a married & somewhat older student who is hoping to start a family in the near future, I am curious to hear some perspectives

My husband is entering med school next year so he is a year behind me. We will either couples match, or I will be a year ahead and he will try to match me geographically (we're hoping to be in NY anyway). The dean at my school recommends staggering it, saying that my being somewhere already provides far better leverage, and couples matching is so risky.

My question is for fellowships... we are each interested in fields that require one (I KNOW it is early and we could well end up changing our minds, but better to begin understanding the process just in case)... what is the process like for married couples matching into a fellowship at the same time? Would this also be a situation in which it may be better to stagger by a year (me one year ahead, he follows me)?

It just makes me anxious if I'm always a year ahead, because if we end up having children in the next few years as is our hope, that would obviously complicate things--if it was just the two of us we could spend a year long distance, but probably not a good idea if kids are involved.

Please be kind... I've seen some animosity in threads about balancing family/motherhood and medicine lol. We are living near family and will be able to afford some help, so childcare isn't as big of an issue as keeping the family together geographically

Thanks!!

Not all fellowships are done through a match and given the amount of spots is usually smaller, it will be tougher.

 

[kjj17]

Not all fellowships are done through a match and given the amount of spots is usually smaller, it will be tougher.

Sorry I should clarify, both fellowships we are currently interested in are MSMP

 

[ACSurgeon]

Sorry I should clarify, both fellowships we are currently interested in are MSMP

What's MSMP?

Are you planning to go into the same field? Same fellowship?

I'm not sure what you're asking. Fellowship can be just as stressful as residency or a lot easier. Depends on the field.

Are you asking about odds of staying in the same city? This will depend on program size and your stats. I'm sure there are tons of IM spots in NY area. Urology/plastics/derm might be a different story.

Finally, you're absolutely right: it's too early to worry about this stuff. I'm happy to answer questions about training, but don't worry too much about it now. When the time comes, and you know exactly what you want to do, you'll find a way to do it (many ways to spend a year as you wait for your SO to catch up).

 

[kjj17]

What's MSMP?

Are you planning to go into the same field? Same fellowship?

I'm not sure what you're asking. Fellowship can be just as stressful as residency or a lot easier. Depends on the field.

Are you asking about odds of staying in the same city? This will depend on program size and your stats. I'm sure there are tons of IM spots in NY area. Urology/plastics/derm might be a different story.

Finally, you're absolutely right: it's too early to worry about this stuff. I'm happy to answer questions about training, but don't worry too much about it now. When the time comes, and you know exactly what you want to do, you'll find a way to do it (many ways to spend a year as you wait for your SO to catch up).

they are both included here http://www.nrmp.org/fellowships/medical-specialties-matching-program/
2 different fellowships

and yes, I'm asking about the odds of being together or separated geographically, and whether it's better to try to sync up our schedules (via a research year or something) or if I should always stay a year ahead

and actually I don't think it's too early to be worried about per se, because this is something that factors into whether we decide to have kids or not. if it's very difficult to stay together, we may just decide to put off having kids. I dunno. but I definitely want to get a feel for the situation to help with our family planning

 

[TBV]

You are not giving anyone enough details to tell you anything of substance and for that reason I'm out.

 

[kjj17]

You are not giving anyone enough details to tell you anything of substance and for that reason I'm out.

what details do you need? the residencies of interest are IM and/or FM, the fellowships of interest are Geriatrics & Medical Oncology, but those are highly likely to change given the stage of our medical education, so I didn't think specifics were necessary. I'm just curious to hear general opinions on a variety of situations so I didn't realize specifics would be very helpful

 

[ACSurgeon]

they are both included here http://www.nrmp.org/fellowships/medical-specialties-matching-program/
2 different fellowships

and yes, I'm asking about the odds of being together or separated geographically

and actually I don't think it's too early to be worried about per se, because this is something that factors into whether we decide to have kids or not. if it's very difficult to stay together, we may just decide to put off having kids. I dunno. but I definitely want to get a feel for the situation to help with our family planning

If staying together is your top priority, you can make it happen. If finishing in the quickest number of years, you can make it happen. If matching a particular specialty or particular city is your top priority, you can make it happen. Make all the above happen at the same time, now that might be difficult depending on how competitive you two are, and the chosen specialty.

To me, it seems like trying to couple's match is your best bet to match in the same geographic location. It doesn't guarantee anything, but at least you can rank large cities with multiple programs highest, and still rank options that would separate you to avoid not matching. If you match a year ahead of him, that means he only has x number of programs to match into, or he'll have to be further away. If you want to do FM and there are 10 within a 1-2 hour drive from NYC, then you can match a year ahead of him, and he should be able to match nearby. The number of spots of each specialty in your chosen city will make all the difference.

 

[chronicidal]

The dean at my school recommends staggering it, saying that my being somewhere already provides far better leverage, and couples matching is so risky.

This is nonsense advice. The reason that it can be better leverage is that some PDs recognize what a crappy situation you are in and want to help you out. The risk is the same as entering the couples match. The unmatched rate for couples is the same as for individuals. You should enter the couples match if your top priority is being in the same place. You should enter the match solo first if the small risk of being separated is outweighed by your desire to go to the program or location of your choice or to start earning a salary sooner.

 

[deleted564680]

I mean if we're going to play odds and speculate about the far future then you are more likely to get divorced than end up in the same place for fellowship. Take one day at a time.

 

[Merely]

lol

 

[HelpPleaseMD]

answer I believe is yes. geriatrics though is not competitive at all so I doubt matching in the same city will be an issue

 

[FlowRate]

Wow I'm sorry this thread has been so unproductive for you. Not sure why the other posters gave you so much crap.

Are you at a school where it's not-atypical to spend a year doing research? It might be easiest to sync back up by doing a research year.

The Match favors couples over individuals, provided the couple is somewhat equally-competitive for their chosen specialties. It would be easier to match in the same location as a couple applying in the same year.

I don't know enough about fellowship match to give good advice, but I think that fellowship match also allows couples matching, which is again beneficial.

 

[kjj17]

If staying together is your top priority, you can make it happen. If finishing in the quickest number of years, you can make it happen. If matching a particular specialty or particular city is your top priority, you can make it happen. Make all the above happen at the same time, now that might be difficult depending on how competitive you two are, and the chosen specialty.

To me, it seems like trying to couple's match is your best bet to match in the same geographic location. It doesn't guarantee anything, but at least you can rank large cities with multiple programs highest, and still rank options that would separate you to avoid not matching. If you match a year ahead of him, that means he only has x number of programs to match into, or he'll have to be further away. If you want to do FM and there are 10 within a 1-2 hour drive from NYC, then you can match a year ahead of him, and he should be able to match nearby. The number of spots of each specialty in your chosen city will make all the difference.

gotcha thanks a bunch!

Wow I'm sorry this thread has been so unproductive for you. Not sure why the other posters gave you so much crap.

Are you at a school where it's not-atypical to spend a year doing research? It might be easiest to sync back up by doing a research year.

The Match favors couples over individuals, provided the couple is somewhat equally-competitive for their chosen specialties. It would be easier to match in the same location as a couple applying in the same year.

I don't know enough about fellowship match to give good advice, but I think that fellowship match also allows couples matching, which is again beneficial.

haha I expected a mix of helpful and snarky 😛 but yeah, the dean seemed to encourage me taking a year off to do research, but said it may not necessarily be advantageous to be sync'ed up, so she wouldn't necessarily recommend me doing research if only for that reason. I dunno lol. I'm also worried about fellowship matching later on. in either case, I do know we want to be in NY which has some of the most options of any city

 

[235009]

My advice is to apply separately for residency then sync up for fellowship. Taking a research year is going to be low yield + more debt. There are plenty of community IM programs in nyc that it won't be hard at all for both of you to end up there if that's your #1 priority. Then you can take a year off after residency, make some money as a Hospitalist then couples match for fellowship. Heme/onc will be the limiting factor as geriatrics is wide open. Good luck!

 

[DoctorLacrosse]

You are not giving anyone enough details to tell you anything of substance and for that reason I'm out.

roflll... did you just straight shark tank the OP? that's a gem

but OP, I think geriatrics isn't too competitive, nor is FM/IM (speaking generally, not top big name programs), so I think this can be done. good luck!

 

[IlDestriero]

You're much more likely to match in the same city for residency than a fellowship. That's just the numbers.
Being a superstar applicant gives you far more options and leverage than an average applicant. Some people are lucky to get interviews, others are actively courted everywhere they go.
You know what you have to do.

 

[chronicidal]

We're talking about an M1 and M0 here. There is a much higher probability of going into specialties that are not FM + IM than the probability of actually ending up in FM + IM. Going for anything more competitive will tip the calculus towards couples matching instead of solo/staggered.

If you end up going into FM/Geriatrics and IM/Heme-Onc as planned, you're very lucky that only this year did the NRMP Board of Directors allow specialties that recruit from multiple core residencies (Geriatrics from IM and FM) to join a match cluster that recruits mostly from one (MSMP). Geriatrics used to be a separate match, but now you can couples match Geriatrics and other MSMP specialties.

 

[FlowRate]

gotcha thanks a bunch!


haha I expected a mix of helpful and snarky 😛 but yeah, the dean seemed to encourage me taking a year off to do research, but said it may not necessarily be advantageous to be sync'ed up, so she wouldn't necessarily recommend me doing research if only for that reason. I dunno lol. I'm also worried about fellowship matching later on. in either case, I do know we want to be in NY which has some of the most options of any city

Your dean doesn't understand the match. Don't worry, most people don't and, unfortunately, the exact method by which couples are favored is not public knowledge (although I think the public part is the major thing: you effectively get many more ranks.) Rest assured, though, couples matching (if your goal is to be in the same location) is infinitely preferable to trying to match separately--in the case where your optimization criteria is landing in the same location.

If you match separately, your fiancee needs to be a competitive candidate. If he's not, it'll help if you match in a big city with multiple programs (Boston, NY, etc.)

 

[kjj17]

thanks so much everyone! realizing now just how little I understand about fellowship matching, so it's time to research that first.

I know geriatrics is a wide open field which is why I didn't mention it at first haha, cus there's a good chance he'll change his mind.

in the (likely) event we stray from our current interests and don't end up pursuing fellowships in the same cluster, thus allowing for couples matching... how risky is it to match for fellowship at the same time? In that case would staggering be better? thanks 🙂

 

[NotAProgDirector]

The dean at my school recommends staggering it, saying that my being somewhere already provides far better leverage, and couples matching is so risky.

This has been commented on above, but I wanted to address it specifically. The couples match is not "risky". You can't do worse in the couples match then you would do matching on your own. The couples match gives you the most control over where you both end up for residency. That said, see below, it may not be worth delaying graduation a year for it.

The Match favors couples over individuals, provided the couple is somewhat equally-competitive for their chosen specialties.

...unfortunately, the exact method by which couples are favored is not public knowledge (although I think the public part is the major thing: you effectively get many more ranks.)

This isn't true either. The match doesn't favor couples, it just processes their lists together. You won't match higher on your rank list as a couple than you would matching alone. The couple's match does require a longer rank list, but that's because programs are repeated on your list to generate all of the possible combinations between the two.

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In any case, advice is as follows:
1. If you both apply to relatively non-competitive fields with large numbers of spots (like IM and FM), then you'll probably do fine without the couple's match. Whichever of you is ahead will simply match to some large urban center, and then the other person will match also.
2. Delaying a year and using the couple's match will be in your best interest in the following scenarios:
A. He decides to apply to a competitive field with a small number of slots. Ortho, Derm, ENT, Plastics, etc. In that case, you probably don't want to commit to any one location, since there is no guarantee he's going to get a spot there. Note that if you decide to do so, you could simply apply broadly, and then he can target whatever city you match in.
B. You really both want to be in the exact same program. There are some benefits to doing so. Although this might work out applying in separate years, you'll have much more control in the couple's match.
C. He is a weak candidate. Poor step scores, failed classes, poor clinical performance, etc. In that case, you have the same problem as A, you might not want to commit yourself until you know where he is going.

Unfortunately, you might not know about the issues in #2 while you're applying to programs. When you're applying at the beginning of your MS4, he'll be 3 months into his MS3. He could still fall in love with ortho, etc. So you will need to make your best guess. And if you match to somewhere in IM, and he matches somewhere else to Ortho, you can probably transfer programs to stay together -- not the easiest, and best avoided if possible, but can be done.

Finally, when you get to fellowships, you'll face the same issues. But that's so far off in the future, I wouldn't worry about it. And as already mentioned, financially it's a much better plan to finish your residency and then work as a hospitalist for a year than to take a year off during your training. But so much may change between now and then, you shouldn't worry about it.

 

[kjj17]

that was super helpful, thank you so much for such a long & thoughtful response 🙂

 

[chronicidal]

the exact method by which couples are favored is not public knowledge

Reiterating what aPD said, the Match algorithm does not favor couples. Couples end up doing just as well in terms of match rate as individuals, despite constraining their rank list with another person's rank list, probably because couples compensate by applying to more places and communicating with programs more.

 

[FlowRate]

Reiterating what aPD said, the Match algorithm does not favor couples. Couples end up doing just as well in terms of match rate as individuals, despite constraining their rank list with another person's rank list, probably because couples compensate by applying to more places and communicating with programs more.

I've been trying to find the source of my claim, but can't remember which article I read it in. I can undoubtedly slightly modify the claim that if a couple acts as a single, they are favored in the match.

Here's the best I can do on citation for the time being: https://dash.harvard.edu/bitstream/handle/1/2579651/Roth_Deferred Acceptance.pdf?sequence=2

(and in case anyone missed it, that article was written by Roth as an overview of the work that came from the Roth deferred acceptance algorithm, AKA the Match--the formal proof of the algorithm and essentially the creation of a new field of economics is why he won the Nobel.)

 

[NotAProgDirector]

Thanks for the link. The TL;DR version is that we're both wrong, sort of.

Ideally, you want the match to result in the "best" solution. However it depends on how you define "best". Let's imagine a match where half of the applicants get their 1st rank, and the other half get their 3rd rank. Then, let's assume that with the same data, we could also match everyone at their 2nd rank instead. Which is "better"? That's a hard question to answer. Or, imagine that one solution has 10 people matching to various ranks, and another solution has 9 people matching to better ranks, and one person not matching. Defining which is "better" isn't easy.

In a perfect world, the match would result in one single answer that everyone agreed was "best". But it doesn't. 99% of all of the possible answers are the same, but there's always some variation possible. Take a look at this thread: http://forums.studentdoctor.net/threads/match-conundrum.1046918/ It's important to look at post #16 and the discussion that follows. Bottom line is that "ties" can develop, and how they are settled can change the outcome of the match.

All of the above is ignoring the effect of couples. Couples create a whole new level of problems for the match, mathematically. Without couples, once you are bumped out of your #1, there's no hope of going there. Everytime someone else is bumped out, it's because someone higher on the program's list has prelim matched there. This is good -- it means that the algorithm is mostly linear. But couples create a new, circular problem. Let's say you get bumped out of your spot at your #1 TBH (The Best Hospital) by Joe Schmo. However, Joe is couples matching with Mary. Mary gets bumped out of her program by someone else, so Joe now gets removed from TBH's list (and presumably placed at the next place on his list). Now that spot at TBH is open again, and you should have a shot at it. That's the new problem created -- a spot at a program can open up because the partner of a couple gets bumped out by the usual match algorithm. Fixing this is not easy -- in fact, the article you linked explains that there isn't really a fix. Some "fixes" don't find the best solution. Others are open to manipulation (i.e. that ranking people/programs in some order other than your true preferences might yield a better outcome).

None of this suggests that couples have some sort of advantage, however. They just make the matching process more complicated.

My (complete) guess (since I don't work for the NRMP at all), or "how I would do it", is like this:

1. Run the match for all the non couples first.
2. Then add all the couples in, and get them to settle into spots
3. This will bump some people off lists, so then reprocess all of those until everyone is settled.
4. Once it looks like it's all done, I would go back through each person's rank list and make sure that they can't be placed into something higher on their list. If so, fix that and try again.
4B. I might try rerunning the match with the people who did not match removed (see the above post/thread).
5. Once you get that done and have a stable solution, I'd probably try again from the beginning processing lists in a different order. Ultimately, you'd need to measure some sort of goodness-of-fit for each solution, and pick the best one.

Remember that, with all of this, all "best" solutions are exactly the same for 99+% of people. We're tinkering with the edges.