Please help! how do NRMP match rules work?

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Laura7

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I guess this is a question for a program director if one is around.

I matched at my first choice program and hope to still go there. My husband and I both chose the location of my top choice (though I'm very happy to go there). We had been having problems and this week he completely surprised me by suddenly moving out; there is some hope we can salvage things. We aren't currently living anywhere near where I matched and our original plan was that he would join me in my match city a few months after I started due to his job situation. I think if I start on time, there's virtually no chance we can stay together.

I have not yet signed the match contract for my program, but it's due quite soon and I did commit by signing the NRMP agreement. I really like the program and don't want to screw them over. I'd definitely like to go there when things get better. I also don't want to end my relationship because we don't have enough time together to work things out (he's been out of town for 3 months and just got back recently). What can I do?

I guess my main questions are:
-Do people ever defer for a year or part of a year or is this impossible?
-How do I go about talking to the program?
-Is this a situation where I would be likely to be granted a match waiver by the NRMP?
-even if I were granted a waiver, would it be a huge black mark against me (I'm a strong candidate in my chosen field)?

Thanks. I'd appreciate any info from those who have dealt with something like this.

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Residency isn't like med school - spots exist in residencies because people are needed to actually do the work. There really isn't a lot of flexibility - if you matched there and don't show up, then everyone who is left has to fill in the gaps. "Deferring" is not really an option in most cases simply because of these facts. There are residents who take time off during residency but this is often worked out well in advance. While your circumstances may be important to you, to be honest your reasons are entirely personal and it is a personal choice of yours to go or not go. You weren't in an accident. You aren't seriously ill.

I would suggest you talk to your program as soon as possible about it. I would suspect your options are going to be either
1) Withdraw completely and go through the match again next year (or take a spot outside the match)
2) Do the residency
You never know, maybe this year's residency is a big class and they will give you a break, but you aren't going to know that unless you talk to them.

The first few weeks of residency are often the most important and you are unlikely to be able to skip these and still work the year. I suppose one possibility is that they would have you show up for the first month, then take a month or two off (elective time) and then return, but that would be something you would have to work out, would cause problems with scheduling, and is not going to be the program's first choice.

As to how you go about talking to the program, just call them. It's going to be uncomfortable no matter what.
 
I'm sorry that you're going through this. I'll try to answer your questions. You posted your question in the "wrong place", so I removed it and figured I'd answer it here.

1. You can try to request a match waiver. I honestly don't know if it will be granted or not. Theoretically, you're only supposed to get one for a major unexpected change in your circumstances. I could see someone arguing that you should have known that your relationship was deteriorating. Still, I expect that it might be granted for something like this.

2. You usually can start late. You can ask -- it can't hurt. If you request a late start, then you definitely have to go -- it would be a real crime to your future program if you asked for a three month delay, then dropped out. This would kill any chance of them finding someone to take your place. If you're a good candidate, they may be willing to be flexible. This happens all the time with prengancies.

3. You are unlikely to get a deferment for a whole year. In that case you'd need a waiver from the NRMP, then apply again the next year. Depends on the program whether they'd be willing to consider you again. Also depends on how competitive the field is -- if this is ortho, this may be your only shot.

4. Would it be a black mark? Depends. It will definitely be an issue for discussion. What PD's will want to see is that the issue is resolved.

Some honest advice:
Internship is really hard and busy. It's a tremendous amount of fun (if you look at it that way) but involves long hours and lack of control of your schedule. A good relationship while a resident is a lifesaver -- someone who doesn't mind that they have to do all the housework while you're on a call month, etc. In general, I have seen internship destroy most relationships that were not going well -- all relationships are give and take, but when you're an intern you'll be taking much more than you're giving.

If you need a year to fix your marriage, you should consider doing so. I doubt that 3 more months of deferment is going to fix your marriage, and I doubt any program will hold your spot open more than that. I'm not sure that 12 more months will either, but it may be something that you're willing to invest. Regardless, remember that internship (and residency) will be hard on your relationship, and you'll need to prepare your partner for this.

Which leads to the one "catch-22" in all of this: If you take a year off and can't save your marriage, then you re-enter the match and this episode becomes part of your personal statement. It's "resolved", and I doubt anyone will hold it against you (again, unless you're in a surgical field which tends to feel that work is more important than personal issues). If you put your marriage back together, then your re-match becomes a bit more complicated -- I'll ask you about it and if you tell me that "my husband will come join me once he finds a new job around here", your application becomes worrisome. You'll need to prove to PD's that you won't bail out again because of your relationship.

Hope that helps.
 
Just my 2 cents . . . and I am by no means knowledgeable in this arena...

I believe you should really ask yourself the big questions such as:

1. can the marriage really be saved?

i understand you don't want to post the details, but clearly, all your troubles did not happen overnight, and "staying with him" will not be an instant salve. I don't understand why he moved out or why it would be impossible for him to follow through on your plan to move to the area where you matched.

2. can you live with yourself if you decide to go for internship and the marriage falls apart?

3. can you live with yourself if you decide to forego internship this year and the marriage still falls apart?

4. can you really forego the match you earned and say you are doing this for yourself and not just for your husband?

I just don't want you to see you play the martyr card, because more often than not, the "sacrifice", which was done with the best intentions, can eat you up inside and leave you bitter...I've seen that happen to alot of good women.

Good luck :luck:
 
Having been in a marriage of nearly 20 years that ultimately ended in divorce I felt inclined to give you some insight.

I was not happy and the relationship was very one sided. I chose to leave the marriage so that I could focus more on my needs. Yes, it sounds selfish, but after so many years of taking care of everyone else (we had 2 children together) I realized it was my turn. I needed to be able to focus on my own goals and work toward them.

It was the best decision I could have made for myself. I entered in to a much better relationship just before medical school started, and without that support I'm not sure I would be where I am today, but I do know that if I had stayed in the first relationship I definately would not be here. I am a stronger and better person for putting myself first for a change.

Talk to your program director and tell him/her about your difficulty. They can be your best ally in helping you make decisions that could affect the rest of your life. I wish you all the best and hope things work out for you.
 
Sorry to hear about your situation, I imagine it must be very tough....My advice to you is to NEVER EVER give up your career for a man.... for your kids ok maybe, your parents or siblings perhaps... but a man... especially one that left you no way NEVER!

Do your program, if he loves you he will still stay with you or/and move with you!

good luck to you

Ocean11
 
Sorry to hear that, OP. My husband and I are also planning for him to follow me to my 1st choice later, depending on when he gets a job. I love him very much. I have to say, though, if he suddenly up and moved out, I would be sure to show up to orientation on time with bells on. Why?

Because as others alluded to, residency is tough. If he can't deal now, whether it's due to differences in opinion, infidelity, etc, he won't be able to deal later. The only way I would even consider taking a year off is if it was totally my fault (I cheated, etc). Of course, you should never let someone on an anonymous internet forum give you relationship advice, but think very carefully before you do this. The fact that he up and moved out seems to send a VERY strong signal your way, and you may be deluding yourself about your chances. It may even be that some time apart can give you both the perspective you need to potentially work things out, you never know....
 
Sorry I've been MIA. I'm new to the forum and I didn't realize I had gotten more posts....

I'm still thinking about what to do, but just wanted to say I really appreciate your advice and kind words. It continues to be a bad situation but things are going pretty well for me and I'm feeling more confident my career will be ok. Thanks, guys.
 
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