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an online version of the magazine Spring/Summer 2007
Annals of Hopkins

The Glow of The Match

In the old days, the fate of med students looking for residencies could be determined through side deals and an old boys’ network. With the Class of 1952, all that changed.


By Michele McFarland


IFor 56 years, it’s happened pretty much this way: At just about the same moment in March that the wind whipping across Broadway turns gentle, fourth-year students at the School of Medicine stream into one of the school’s auditoriums. They wisecrack. They feign nonchalance. And they feel anything but. For this is Match Day, the event where graduating med students retrieve envelopes telling them the names of the hospitals where they’ll train to become practicing physicians. A computer at the National Residency Matching Program (NRMP) has determined their fate.

“It’s an interesting process, and somewhat unique to the medical profession,” says J. Alex Haller, who ran the pediatric surgery division at Hopkins for 33 years. 

1 1 1
Margolis as a young hoopster.
> The class of 1952 had to “fly blind” the first year of the match system. “Even the dean’s office wasn’t sure how to proceed,” recalls Stewart Wolff ’52.

Haller, whose School of Medicine class of 1951 was the last expected to find residencies without the aid of the NRMP, is all for the formality of today’s system—for letting a mathematical algorithm match students and hospitals. “Today, the computer bears the anguish,” he says. And before the Match Program, finding a residency was quite simply a mess. 

Med students today may spend weeks crisscrossing the nation interviewing at hospitals with plum training programs in the specialty they’ve chosen—everything from anesthesiology to radiology. The process takes time. But in the old days, “it was all of us for ourselves,” says Howard Jones, who graduated from the School of Medicine in 1935. And the lack of a formal system was tailor-made for an old-boy’s network. “Side deals were commonplace, promising careers were arbitrarily impeded, and merit-driven competition was stifled,”  noted the NRMP in 2004.

Jones, who is now 97, can still describe the process he went through to be named to an internship (the old name for the first year of residency) at Hopkins. First, he consulted with “a guy on the faculty named Monty Firor,” a general surgeon and the self-appointed internship consultant. Firor confirmed Jones’s inclination toward gynecologic studies and encouraged him to try for a position at Johns Hopkins. “His was the only conference I had on the subject,” Jones says. “After you applied, you had to make yourself known. The best way to do that was to act as a substitute for an intern going on vacation. I must have nosed around a bit to see who was going away.” Jones secured his Hopkins residency and went on to become a leader in reproductive medicine here and then at Eastern Virginia University

Not everyone was so lucky. “You were competing with your own classmates for slots,” Haller says. When he received offers of a surgical internship from both Hopkins and Harvard, he remembers worrying about how his decision would affect his classmates. He knew that for some, he’d be freeing up a coveted spot. For others, he’d be taking one away. “Your life was in someone else’s hands,” Haller says.

Eighty-year-old James Hudson Jr. of the Class of 1952 also testifies to the arbitrariness of the pre-match system. Some students in the classes ahead of his, he says, simply “wrote to Johns Hopkins and said they would like to be an intern. If the faculty reading the application saw a real hot shot, they would go for him.”             

With such inequity, the process, of course, had to change. And it did. The 5,580 U.S. students who finished medical school in 1952 may have felt in a fog about how the strange new match system would work, but they made history when they became the first class to apply for internships that way.

“We were flying blind that first year,” admits Stewart Wolff, a retired ophthalmologist from the Wilmer Eye Institute and member of the Class of 1952. “There was no particular instruction. Even the dean’s office wasn’t sure how to proceed.  We talked to our classmates to find out what they were doing.” The group turned in computer punch cards indicating their five or six choices for processing in an old IBM machine. And just as today, hospital departments also ranked the med students who’d applied for their residency slots.

“The Match was supposed to level the playing field,” recalls Hudson, who recently retired to his Tennessee farm after a career as a pediatrician and University of Maryland associate dean. “It wasn’t perfect on the first trial. There were a few students making deals on the side. Still, it was about an 80 percent improvement.” 

Today, after 56 years of operation plus gigantic leaps in technology, the match program works like a well-oiled machine. In 2008, for a $40 application fee (up from $2 in 1952) the NRMP paired some 30,000 applicants with an unprecedented 25,000 residency positions. Among them were an increasing number of international students, and American graduates of foreign or osteopathic medical schools, categories that are matched only after U.S. medical school seniors are placed.

Hopkins medical students, according to Associate Dean for Student Affairs Thomas Koenig, face the Match with anticipation and trepidation. “Many of our students are good at taking control and making things happen for themselves. With the Match, their future is decided through this kind of black box process.”

Each year, of course, a few medical students around the country don’t match anywhere—mostly because their rankings haven’t gelled with the hospitals they preferred. For them, the NRMP softens the blow by letting them know 48 hours prior to Match Day. They then become throwbacks to an earlier era—scrambling to find a slot just like their counterparts of 60 years ago. Invariably, they succeed. 

It’s possible, of course, to eschew the ceremony of Match Day completely. Students who choose can simply retrieve their residency placement through the Internet. Match Day, however, has taken on a certain symbolism over the years, so few want to miss it. As students tear open their white envelopes, cocooned by friends and family, to many, the moment connotes the beginning of their professional lives.

Still, a few old-timers can’t help feeling that the process has grown rather time-consuming. “The Match plays havoc in the medical school,” laments Robert J. Faulconer (Class of 1947), who teaches pathology in Norfolk, Virginia. With all the interviewing that goes on, “the fourth-year students are hardly here. In our day, you could decide where you wanted to go, write to the chairman for an application and wait for a reply. It was all done through the U.S. mail and Western Union telegram.”


Michele McFarland is a freelance writer based in Baltimore.



 Music on the Mind
 The Protectors
 Practicing On Plastic
 Troubled minds, troubled hearts
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
Class Notes
 Our Man in Nashville
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2008