Bleeds Like Stink

“I love that song. I sing it all the time while I wander the halls of the hospital.”

–Boswell, MD

—–Original Message—–
Subject: Re: 2006 Match

Greetings!

Congratulations again on your wonderful Match! According to the NRMP, the 2006 Match was one of the most successful Matches ever, breaking records for the number of residency positions offered and filled. A total of 24,085 positions were available and 22,427 of them filled. An outstanding 85% of US seniors matched to one of
their first 3 choices.

You did it!!

And…

MORE U.S. MEDICAL SCHOOL SENIORS CHOOSE RESIDENCIES IN
COMPETITIVE AND “LIFESTYLE” SPECIALTIES
Match Day ceremonies held across the nation

Washington, D.C., March 16, 2006 — At noon today, 15,000 upcoming graduates of U.S. medical schools will participate in “Match Day” and learn where they will spend their years of residency training. According to the National Resident Matching Program (NRMP), which matches the medical students to residency positions, many of these students are choosing to pursue careers in highly competitive medical specialties, such as surgery, dermatology and anesthesiology.

This year, 26,715 applicants participated in “The Match;” 15,008 of them were U.S. medical school seniors. (Other applicants include: physicians who have already graduated, osteopathic students and physicians, and graduates of non-U.S. medical schools.)

Conducted annually by the NRMP, the Match uses a computer algorithm to align the preferences of applicants with the preferences of residency programs, in order to fill the available training positions at U.S. teaching hospitals. The Match has a very high success rate—93.7 percent of U.S. medical school seniors matched to a first-year residency position. Of those students, 84.6 percent matched to one of their top three program choices.

Match results are an indicator of career interests among graduating medical school students. Several popular specialties are highly competitive:
- Almost 22 percent of the available first-year residency positions are in internal medicine programs—the largest specialty in the Match. These positions are competitive: 98 percent were filled, 56 percent of those were filled by U.S. medical school seniors (the highest number in three years).
- Otolaryngology (ear/nose/throat specialty) positions are new to the Match program this year. 98 percent of those positions were filled, 92 percent of those were filled by U.S. medical school seniors.
- All but one of the 1,047 general surgery positions were filled through the Match, more than 83 percent of those were filled by U.S. medical school seniors.
- Since 2003, interest in obstetrics/gynecology residency positions has been increasing. 98 percent of these positions were filled this year, 72 percent by U.S. medical school seniors (up from 68 percent three years ago).

In recent years there has been increased interest in the “lifestyle” specialties—those considered to have more reasonable work hours and demands:
- All first-year residency positions in dermatology were filled through this year’s Match, with U.S. medical school seniors taking more than 93 percent of those spots.
- In anesthesiology, 97 percent of the available positions were filled. More than 80 percent of those were filled by U.S. seniors, the highest number in several years.

Interest in some primary care specialties has decreased in recent years. Mixed results from this year’s Match data show possible shifts in that trend:
- Although there were 50 fewer family practice positions available through the Match this year (continuing a 5-year decline), 85 percent of those positions were filled—up from 82 percent last year. While only 41 percent of those were filled by U.S. medical school seniors, this represents a slight increase (of 6 more individuals) from last year.
- 96.5 percent of available pediatric residency positions were filled through the Match, down slightly from 97.4 percent in 2005. Almost 73 percent of those were filled by U.S. medical school seniors, a decline from 74 percent last year.

Although Match Day officially occurs today, the Match is actually a week-long process. On Monday of this week, NRMP applicants were informed whether they had been matched to a residency program of their choice, although the name of that program was not revealed. On Tuesday, in what is known as “the scramble,” the locations of remaining unfilled residency programs were released to unmatched applicants, who then contacted the programs about the open positions. Today, matched applicants learn where they will spend at least their first year of residency training. For U.S. medical school seniors, this news will be delivered and celebrated during Match Day ceremonies at the nation’s 125 U.S. medical schools. The Match was established in 1952, at the request of medical students, to provide a fair and impartial transition from medical school to residency.

“It’s exciting when you consider that on Match Day, 15,000 medical students across the country are finding out their residency locations at the same time,” said NRMP President Susan Kline, M.D. “And for physicians who have already been through the Match, it’s thrilling to attend these ceremonies and re-live the excitement of our own Match experience.”

# # #

The National Resident Matching Program (NRMP) is a private, not-for-profit organization established in 1952 to provide an orderly and fair mechanism to match the preferences of applicants to U.S. residency positions with the preferences of residency program directors for those applicants. The NRMP is sponsored by the American Board of Medical Specialties, the American Medical Association, the Association of American Medical Colleges, the American Hospital Association, and the Council of Medical Specialty Societies.

Began my radiology clerkship today. There’s a bit of blink response, but much of it is formulaic interpretation of objective data, correlated with a brief synopsis of what’s transpiring in real time. These guys have an enormous fund of knowledge.

It’s a real weekend, a normal Saturday and Sunday without the pressure of working overnight in the hospital, looking for clean underwear, or wondering what day it is. I’ve elected to sit tight this morning and wait for Meet the Press. The coffee is tasty, the sunlight through the windows bright, and I’m out of bed. It’s a pretty good start.

Laundry was a pressing concern, so I gathered up the stuff and wandered down to the basement to see if the machine was available. I have a fairly normal routine when it comes to washing my clothes, which is to let the water fill up part way and mix up with the soap. Then I sift through pockets collecting loose change and bills that typically accumulate there (not a fruitful search today) and throw everything into the soup. It’s a relaxing process for me, not to mention that I usually (not today) wind up with a few bucks for burgers.

I had clothes that needed washing from work, specifically a pair of brown slacks with blood on the front pocket. It sort of slips by during the work-week, these little details of leaning over a table during a procedure in the commotion of a crackling trauma room. The patient was a middle-aged man who had been crushed by his truck after being ejected, and the story was evolving to suggest that he had been awake in the ambulance and still had vital signs as he was wheeled into the trauma bay. At the point I walked into the room, 25 people were either actively helping with the normal sequence of addressing a trauma patient, milling around without much purpose, or simply gawking. I had been seeing patients in a different area of the ED, so my role was much more of the latter two, but with the caveat that I’m almost obliged as a student to be involved, even if it is only to watch. The patient lost vitals on the table about the time I edged into the room, and one of the ED residents was carrying in a thoracotomy kit. Similarly to the other night, the surgeons decided to crack this patient’s chest in hopes of finding a source of bleeding or relieving pressure around the heart. The resident made an incision from just below the nipple and extended it laterally down to below the armpit to the level of the table. He then bluntly dissected the intercostal muscles with a pair of Kelly clamps, and then inserted a set of rib-spreaders. This is all done on the left side of the chest for the sake of providing the best access to heart, and in a matter of moments. The pericardium was then incised (with care taken not to divide the phrenic nerve) and observed for blood, fluid, clot, etc…his was clear, and the surgeons decided to extend the thoracotomy to the right side, a procedure known as a “clamshell” in the trauma world. Another resident during this time had inserted a chest tube on the right side with extensive blood gushing from the tube, and it was assumed that the patient was hemorrhaging from some sort of shearing injury. It didn’t matter, though–the patient had no pulses, the bleeding couldn’t be stopped, and after a few minutes, the effort to resuscitate him ended. I had worked my way to the head of the table by this time, which is where I leaned in for a better view for the bilateral thoracotomies and the resulting anatomy lesson. I’m still not sure why I’m so objective about all this. For students and residents, tragedy simply evolves to education, often without reflection.

Interesting night at work last evening/this morning. It was pretty quiet until after 3 a.m. or so, just a few people looking for narcotics and one woman with an infected knee status post left knee replacement, and then the trucks began arriving. The first was a stab wound, followed by two gunshot victims, all of whom were in extremis and near death. The stabbing victim required a thoracotomy, which is the fancy word for cracking the chest with a huge incision from the sternum to the flank and rib spreaders. He had a puncture to the left ventricle, which caused the fibrous sac around the heart to fill with blood and clot. The right ventricle, visualized with ultrasound, collapsed from the pressure. He lost his pulses until the surgeon released the pressure by opening the sac and cleaning out the clotting blood. Blood spilled all over the trauma room floor, and the process attracted a huge amount of attention from the staff. I’ve never seen anything like it. He quickly went to the OR and was stable but critical this morning in the cardiac ICU.