National residency program determines fourth-year medical students' destinies
By Jack Mazurak
A marriage proposal and a student record of community service punctuated this year's School of Medicine Match Day Ceremony against a backdrop of the school's mission - training physicians for Mississippi
On Match Day, a simultaneous event across the country, fourth-year medical students find out where they'll receive specialty training. Residency training ranges from three to seven years depending on specialty.
Through four years of medical school the objective to train more doctors for Mississippi - particularly in primary care specialties - gets discussed as much one-on-one in offices and in specialty interest-groups meetings after hours as promulgated from lecture-hall podiums.
At Match Day on March 16, the results rang out to a crowded house of students, families, faculty and supporters: Better than 40 percent of the class will enter primary care residencies and more than 40 percent will train in Mississippi. Solid figures.
School of Medicine students will head to states across the nation - north to Minnesota, south to Florida, west to Oregon and east to Massachusetts. They matched to 22 residencies including urology, plastic surgery, ophthalmology, family medicine and neurology.
This year 45 of the 107 students will stay in Mississippi for residencies.
"We're always pleased when students opt for residency training in Mississippi because the likelihood of them ultimately practicing in Mississippi is increased," said Dr. LouAnn Woodward, School of Medicine vice dean.
"Forty-five students staying in Mississippi is less than the average of 55-60 percent, but consistent with minor variations we see over the years. However, our students matched at very impressive institutions out of state and we know they'll represent Mississippi very well."
Exactly 43 percent of the class matched into primary care residencies. That will help ensure a supply of front-line physicians who can treat and prevent a broad range of issues in a wide spectrum of patients.
"The need in Mississippi for primary care providers is great," Woodward said. "While our primary care figures this year are very positive, we will continue efforts at the undergraduate medical education and graduate medical education levels to increase interest in primary care."
Jackson native Amika Sood will spend the next three years training in pediatrics, a primary care specialty. She matched to the University of Arkansas, her top choice.
"Of course I love UMC and I want to come back here. It's nerve-wracking to start building all over again in a new place, but it's time to get out and see a different perspective that I hope I can bring when I do come back," she said.
Like many of her classmates, Sood dove into community and extracurricular activities. She volunteered at the Jackson Free Clinic beginning as an undergrad at Mississippi College. She helped out in the Children's Hospital Emergency Room, encouraged other students to consider working with children through the Pediatrics Interest Group and served as a class liaison between students and professors on disputed test questions.
"I'm definitely not the world's greatest at balancing all that, but I've learned to manage these things over the years," Sood said.
"You can't study all the time and these are actually stress outlets that help put things into perspective. Your first and second years of medical school in particular are so tough that it helps to get into a clinic and see the big picture again of why you want to do this."
Eric McClendon matched to an internal medicine residency, another primary care specialty, at Wake Forest Baptist Medical Center in North Carolina.
"Deciding on internal medicine had a lot to do with our Internal Medicine Department. It was my first rotation as a third-year medical student," he said. "I liked the idea of knowing a little about everything, and I have an interest in cardiovascular disease, so I might go on into cardiology."
McClendon said there's no time during medical school for community activities.
"You just have to make time whenever you can. I wouldn't be where I am now without people helping me along the way, so I feel like it's important to give back," he said.
Joy and Josh Hughes - one of 878 couples nationwide to register for matches - landed residencies at the Mayo School of Graduate Education: Joy in general surgery and Josh in neurosurgery.
Perhaps the least-expected match came when Channing Twyner, a senior medical student, took the stage with Ashleigh Washington, a School of Nursing student set to graduate in May as a family nurse practitioner.
Twyner announced his match - Mayo in anesthesiology - then asked Washington to marry him. She said yes. The auditorium broke into applause.
The National Residency Match Program uses a computer algorithm to link applicants' preferences with the preferences of residency program directors to fill the training positions available at U.S. teaching hospitals.
The NRMP touted success of a new program this year, the Supplemental Offer and Acceptance Program, which helped place students and physicians who didn't initially match.
Match rates themselves continue to concern medical school administrators and NRMP officials. This year saw more than 95 percent of U.S. medical school seniors match, the highest rate in 30 years. UMMC topped that at 97 percent, its highest rate ever.
But more students and physicians apply for residencies every year than there are positions. According to the NRMP, 38,377 people applied for residencies nationwide. That's up 642 from last year and an increase of more than 2,400 over the last five years. They applied for 26,772 positions, an increase of only 614 from 2011.
Much of the problem comes down to dollars. The U.S. Centers for Medicare & Medicaid Services funds a majority of residency slots nationwide but funding has remained flat since the mid-1990s.
The nation needs more doctors, so medical schools are expanding. But that creates a bottleneck at the specialty training level, leaving individual schools, states and medical centers to pay for new residency slots.
Mississippi is a microcosm. Facing the nation's lowest physician-to-patient ratio, the School of Medicine grew its incoming class from 100 students in 2004 to 135 the past two years.
To address the bottleneck, it added 51 new residency positions through the past eight years -a direct cost of nearly $4 million annually. In all, UMMC pays for about 105 residency slots, nearly a fifth of its total 514 positions.
"We have worked steadily to grow our residency positions each year. It is critical the number increases at a pace consistent with growth of the medical school class size," Woodward said. "Each year, there is an evaluation of needs in given specialty areas and growth potential based on approval by accrediting bodies."
As students and their families left the auditorium in Jackson, their Match Day in the books and with graduation on the horizon, the class of 2012 could look forward to starting residency and heading into practice.