Let me begin with an admission: I never intended to be a pediatrician. When I started my core pediatrics clerkship—a six-week rotation during my third year of medical school to get exposure to pediatric medicine—here at Children's little more than a year ago, it was just another academic hurdle on the road to a career in adult neurology.
It's true that third-year medical students can sometimes be fickle in their choice of specialty; in my own class, I saw would-be surgeons becoming enchanted with psychiatry and radiology, budding dermatologists elatedly discovering ophthalmology and anesthesiology and the great mass of undecideds drifting fitfully toward internal medicine. But I had made it to the end of the year, and it was almost time to apply to residency programs. I had a plan, three letters of recommendation and a plan. Everything made sense.
Needless to say, my plan changed. I went from being certain about adult neurology to "thinking about" pediatrics. At what seemed like the last minute, I decided to apply in child neurology, for reasons that I still can't quite pinpoint. Maybe it was the realization that, as a student, I didn't mind forgoing sleep to help the intern on call, and actually looked forward to rounding on weekends. Maybe it was my rapidly growing collection of finger puppets, for which I desperately needed a rationale. I'm sure that I came up with something convincing for my personal statement. At any rate, the hard question was now not what I would do, but where I would go.
Applying to residency programs isn't like applying to jobs or schools, mainly because applicants don't have the luxury of choosing among offers; instead, they determine what they want in advance, rank their choices and hope for the best. Residency programs, evidently, do the same, and the final outcome is determined by an algorithm called the Match. The algorithm itself is perfectly transparent, a triumph of utilitarianism: It's designed to maximize happiness by giving both parties more or less what they want. The actual process of matching, however, is apparently designed to maximize anxiety, since neither party is allowed to make any guarantees directly to the other. These indirect signals make interviews more like first dates. So, to understand the process from the applicant's point of view, imagine going on first dates twice a week, in different cities, for two months. Except that each date lasts a full day (sometimes two), involves at least two interviewers and doesn't always come with dinner. Thankfully, you can wear the same suit.
In my case, there were two matches to make: an "early" match for child neurology, and an entirely separate "regular" match for the prerequisite two years of pediatrics—meaning two sets of interviews, and, potentially, two different outcomes. Faced with this prospect, I tried to limit my interviews to places I might reasonably end up, with the final selection based mostly on reputation and geography. Medical student lore teaches us that applicants are supposed to do their homework, researching each program and coming prepared with lists of questions to ask in interviews. I didn't do that; I could barely keep track of all the details divulged on interview day about call schedules, elective rotations, outpatient clinics and ice cream socials. I had two questions, both for myself to answer: Is this a place where I would do well? And, is this a better place than Children's?
The first question was usually easy to answer, at least when the answer was "no." The second question turned out to be the difficult one, and also one apparently much on the minds of my interviewers, many of whom observed that I've been in the Boston area for 12 years. It's true that I found myself comparing each new city I visited with Boston—although I learned quickly that it was unwise, especially in New York, to point out the obvious superiority of the Red Sox to any local franchise. I also compared each new hospital with the ones I knew from my medical school clerkships, Children's (where I'd done pediatrics) and Mass. General (where I'd done child neurology), paying particular attention to the quality of rounds and conferences. Of course there were many other differences between the various programs—size, emphasis and personality. At the same time, I knew that all of the programs I'd applied to were excellent, and for me, it came down to a choice between the known and the unknown.
As I struggled with my decision, any number of people weighed in with opinionated counsel: my partner, my partner's parents, my PhD advisor, my friends, my friends' friends and the woman sitting next to me on a late evening flight from Philadelphia to Providence. Only my father expressed no particular bias and said to just do what I thought was best. Despite the chorus of ostensibly helpful advice, it was a sort of private agony. In the end, I chose the known.
The matches, for better or worse, are announced without ceremony. At Harvard, the results are relayed by email from the Office of Student Affairs. When one email arrived—on my birthday—announcing that I'd matched at Mass. General for child neurology, I was at a conference in the Dolomites, and celebrated with a glass of local Lagrein. I was pleased, of course; but more than that, I was relieved. By the time my pediatrics rank list was due, the anxiety had dissipated, and I knew exactly what to do. I was accepted to Children's and chose it—the place I felt was home.