The Match: A testament to the genius of central planning

Source: KevinMD

My father who was a junior doctor in Britain’s National Health Service (NHS) in the seventies would have been grateful for the match scheme, an algorithm that places medical students in residency programs in the U.S. The training in the NHS was unstructured. Physicians carved their own training by joining a patchwork of hospital positions in disparate places.

Over a few years we lived in Yorkshire, East Anglia, Wales, East London and West London. The distances in Britain are trivial compared to the U.S. but the dialects are different. I had to change schools nearly every year. It’s not fun being an eight-year-old Indian kid with a stuttering Welsh accent in East London.

It was taxing for my parents to uproot annually. As disruptive as the fourth year is for U.S. medical students, I think my father would have preferred this concentrated disruption to the disruption he faced yearly.

Twenty odd years later when I graduated as a physician there was slightly more structure in the NHS but still a lot of disruption. In the first two years I changed hospitals every six months. I was not unusual in this regard. This was the norm.

Since junior doctors relied on hospitals for their accommodation, the move had to be in perfect sync. Someone was allotted your apartment just as you were allotted an apartment of a physician about to leave in another hospital. You couldn’t put off moving by a couple of days just because of your work schedule.

On one occasion I recall taking call the penultimate night of my position — someone had to as we were all moving — then loading my possessions in my car and moving to the new hospital only to be told that I was taking the first night’s call. I did not empty my suitcase for a week.

Scarcely would a job start that we would be looking at the British Medical Journal’s classified section (where training positions are advertised) for the next job. Rarely would one get the first job they interviewed. This meant that we had to take time off for multiple interviews. Where would this time come from? Our precious vacation, of course.

With the change in jobs there was disruption to the continuity of care. Just imagine having the July syndrome twice a year and en masse. Each hospital had its own quirks and turf nuances. For example, in some hospitals pyelonephritis was managed by medicine and in others by surgery. These were little details, but were annoying to master, and even more annoying to be shown to be ignorant about.

However, the job switching in the NHS took its main toll on relationships. I can’t count the number of relationships I knew of that ended because partners were careened to different parts of the country. One had no choice. They had to take the training position or be jobless.

No, before you ask, there was no “couples match.” This endearing concept, a remarkably pragmatic gesture crucial for the stability of marriages, is quintessentially American.

U.S. medical students who bemoan the imperfections of the match scheme may not be aware how lucky they are. Medical students from other countries would love to take some of their discomforts. It is understandable that some wish to improve the medical school experience, and the debts incurred by students that would leave Croesus in penury, suggests that much needs to be improved. However, the match scheme is one of its shining assets, a rare testament to the occasional genius of central planning.

Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad.

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