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Playing the match game

Imagine this: You spend thousands on your undergraduate education, toiling through organic chemistry, unspeakable levels of mathematics and other pre-med courses that weed out many of your classmates. You miss parties and family get-togethers. You forget what your pillow feels like.

You take the MCAT (for $270). You apply to medical schools (after coughing up several Benjamins in application fees).

If you’re accepted, you take out student loans and spend four or five years there. You receive classroom instruction and hands-on training with practicing physicians during your clinical rotations, or clerkship. You continue racking up debt, possibly hundreds of thousands of dollars.

As you prepare to graduate, you apply to 50, 60, 70 residency programs across the country. A handful of them invite you for an interview. You put on crisp clothes and woo them to the best of your ability. You rank the programs; the programs rank the students. You need one of those programs — you can’t practice without completing one.

Then comes Match Day — the day of judgment.

One by one, your classmates are matched up with programs they liked that liked them, too. As they learn where they’ll be spending the next half-decade of their lives, there you sit, dejected and rejected. No match.

So…what the hell are you (and your debt) supposed to do now?

You do “the scramble,” said David Kurland, 27, a student at The University of Maryland School of Medicine who isn’t yet ready to apply to residencies.

Students with no match might frantically look for paid internships or spots in a research lab, he said. Others get another degree, like a master’s of public health, before trying again next year. But the debt is still there.

Every year, a small percentage of students find themselves in that distressing scenario, which is the result of fewer available residency slots than graduating med students.

That bottleneck — some call it “the jaws of death” — may be getting worse, thanks to rising medical school enrollment absent an increase in residency programs. An impending doctor shortage, coupled with increased demand for medical care — blame baby boomers on both accounts — means more students will continue to be funneled through the medical pipeline, but funding for more residency positions is far from certain.

The Association of American Medical Colleges is lobbying Congress to pony up more money to pay for more slots. Since 1997, Uncle Sam has footed about a third of the costs of operating 100,000 slots; the colleges cover two-thirds of the costs. Additionally, colleges created 10,000 more residency spots, for which they pay the entire bill (they added the slots to help solve a worsening doctor shortage).

The AAMC doesn’t expect its advocacy to bear fruit in the near future — the budget woes and political climate in Washington are too difficult, AAMC officials said.

In the meantime, current and aspiring med students in Maryland are barreling down on the jaws of death, full speed ahead. Several said they aren’t deterred by the residency dilemma.

“You just have to be realistic about what kind of specialty you have the best chance of getting a spot in,” said Jon Jaffe, 25, who is in his final year at UM.

He submitted his residency applications — 66 of them — in September, and is now gearing up for interview season. He’s hoping for 15 interviews.

He’ll need that many, he said, because his chosen field, orthopedics, is highly competitive. The more interviews you do, he said, the better your chances of getting matched.  For some less competitive fields, 15 applications might suffice, he added.

Last year, four students at UM applied to orthopedics residencies, Jaffe said. Two got matched. Two didn’t.

“It’s a bit nerve-wracking,” Jaffe said. “I consider myself a borderline candidate, so [my chances of getting matched] might depend on how strong I am compared to the rest of the applicant pool this year. They tell us we should have a back-up plan in case it doesn’t work out.”

As for all that debt, they have an answer for that, too.

“Cost will always be a concern, but after a certain point, it’s useless to concern myself with it,”  said Helen Jiang, a 25-year-old who returned to the University of Maryland, College Park to study pre-med after a stint in accounting didn’t work out.

“The debt is inevitable, so the smart thing to do with medical school is to get it done, do it well, get a job, and pay it back.”