 And I just think it's interesting that a non-profit organization is paying their executives so much money and these poor med students who have no money to begin with are paying for all of this. It's, it's interesting. Welcome back to the channel, everybody. For those of you who are new around here, my name is Michael aka Dr. Chilini and I'm a board certified diagnostic and interventional radiologist in New Jersey. Now on today's video, we are going to be talking about none other than that huge thing that's going on right now. Well, just finished actually, but we are going to talk about the residency match process. Why are we going to talk about that? Well, one, at the time of watching this video, it just happened last week, which is always around mid-March or St. Patrick's Day week. And it's always a kind of interesting experience. You have tons of people who match and do well and are really excited. And then you have the other side of things where people don't match and they are not happy with where they matched or not happy with what special tea they got into and all that stuff. So I want to kind of touch on this super anxiety-provoking topic that many people don't know about and see where it goes. Let's go. So first and foremost, I wanted to talk about the actual residency match because a lot of people may not know what it actually is. And if you do know everything about the residency match process, go ahead and skip to this timestamp right here. For those of you who don't know, the residency match is basically a huge algorithm for which medical students match into their specialty of choice. What happens is when you finish your fourth year of med school, you basically go into this huge process where you start interviewing at multiple programs across the country. So for starters, you choose a specialty. You decide what specialty you want to go into after you finish your four years of med school or right before you finish your four years of med school. The process starts around September of the year prior to matching. And by that time, which is usually the start of your fourth year medical school, you should know exactly what you want to do with your life, which is easier said than done because I didn't know what I wanted to do until almost the start of my fourth year, which is a little delayed in terms of matching and all that stuff. So once you have step one complete, you know, you want to do say surgery, you need to start looking at programs. And this is where the whole match process begins. You start applying to programs, reaching out there, sending your CV, sending your applications. And hopefully they will look over those applications. Think you're an amazing applicant and send you an interview invite. Those programs that don't send you an interview invite, you'll probably never hear from it yet. That's just the way it goes. Now, let's backtrack a little bit because before you send out all those applications, how would you do that without spending an exorbitant amount of money that you don't have? Herein lies the NRMP, aka the National Resonant Match Program. Non-profit, might I add. So before this nonprofit organization can spit out your match results, you have to pay fees in order to apply for different programs. So say I wanted to apply for 50 or 100 residency programs in surgery across the country, I would have to pay a fee for each of those applications. Some of them are kind of bundled depending on how many applications you send out and all that stuff. But it changes year to year and I don't want to go into that, but it averages somewhere around like $50 or so. I can't remember exactly how much I spent on the actual application, but I will say that once you get the interview invites from these programs, which is usually a small percentage of how many that you send out, that's where the fees start adding up. But before talking about those alarming fees, in addition to the application fees, let's go ahead and thank today's video sponsor, Stoggles. As an interventional radiologist, I literally use Stoggles every single day and I've been looking for something just like this for a very long time. Stoggles are stylish goggles that are protective goggles that you can actually wear at work. I remind for literally every single procedure I do that doesn't use X-rays. I wear them for ultrasound guided procedures. I wear them for CT guided procedures because you never know when bodily fluids are going to be splashing into your face and this can protect you, which is why I wear them every single day. 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So once these residency programs actually accept your application and want to offer you an interview invite, you accept it with open arms and then you have to go on the interview. Now, luckily last year during the pandemic, you didn't have to go on any interviews, but I don't actually think they went on interviews this year either, but maybe it'll change next year going forward. And that's actually a really good thing because going on all of these interviews costs an exorbitant amount of money. Every interview you go to, you have to pay for a rental car, you have to pay for a flight, you have to pay for a hotel, food, everything, a new suit, portfolio, pen, tie, new shoes, all of that kind of stuff. And you can imagine how these expenses add up. You'll probably spend close to like $500 per out of town interview that you go on. And I think I went on about 10 interviews and probably spent at least five plus thousand dollars just on interviewing. And that's on top of the fees you paid to send out those applications. So as you can see, this is another exorbitant cost to med students spending money that they don't have. I've seen other students open up credit cards just to be able to cover these interview expenses because it can add up pretty quickly. So what happens next? Well, you finally decide which residency program you want to match into. You rank them according to how much you like them. So obviously your number one choice would be your favorite choice. So for me, University of North Carolina, it's my number one choice I wanted to go to. So I ranked it number one. And then the programs ranked all of their applicants one to like 100 or whatever. Then it goes into this huge algorithm and it spits out some sort of match for you. And then it tells you exactly where you're going to spend the next three to five or seven plus years, which is crazy. Now just think about for a second. I said this on the podcast the other day, Joleney Rounds podcast, if you haven't seen it, imagine you were going for a job and they were like, well, we're going to offer you a job, maybe. But if we do offer you a job, we're not going to tell you where it is. We're just going to let a computer decide where we're going to send you. And then you have to stay in that program or that spot for the next five plus years. Like that's that's crazy. Nobody would take that job. But for some reason, this is just what we do in medicine. Again, let me rewind a little bit because once you find out that you match, you find out that you match on a Monday, usually at the beginning of the match wheat. And the reason it's a wheat is because, well, nobody knows, but you find out that you match or don't match on Monday. And then you have to wait all the way until Friday to find out where you match. Just adding a little bit of anxiety onto the already anxiety filled process. Dr. G or Dr. Docoma Fleckin posted a video about the mash process earlier this week. And it's kind of funny. So I kind of wanted to show a little bit of that right now. Hey, boss, I got good news. Oh, Winston, come in. What is it? All the med students have submitted and certified their rank list. Oh, that's great. So can we do it? Hmm. Do what? See, this is the crazy part because we submit our rank list back in like February. And then you wait an entire month for this algorithm to like finally run. Like it's just one button. You just run the algorithm and you should know everybody's residency match immediately. But for some reason, it takes a month. Nobody knows why. Crazy. Oh, come on, Winston, you don't just run the algorithm. It's it's extremely complex as quality checks involve. The whole process will take about two full weeks. What? Two weeks? Yeah, people don't realize the match algorithm takes a lot of work. Really? Because it kind of seems like you just pushed that big red button that says run the algorithm. OK, yeah, we just pressed a button. So what? We still got to wait two weeks before we do it. But why? Why does med school tuition cost $80,000 per year? Why do people still choose to go into neurosurgery? Nobody knows. So it is crazy, right? This whole process, you start it in September the year prior, and then you submit your rank list in February. And then you have to wait an entire month to even know if you match. And then once that happens, you have to wait until the end of the week to know where you match. It's like this huge thing of delayed ratification, which we are all too familiar with, which is why I love that video. So you may be wondering why there are multiple days in between finding out if you matched and where you matched. Well, the reason is because there are still a lot of people that don't match. Now, imagine going through four years of med school only to find out that you did not match spending all of that money on these interviews, on these application fees, travel, etc. And you don't match. So during that time, basically people who don't match, usually it's people who are not competitive enough to match into specialties or are trying to match into very competitive specialties and don't match. They either scramble into another specialty altogether, likely one that they liked less than the specialty they tried to match into, or they end up at some random location they didn't want to be at, and it's a whole mess. So imagine again, you spend four years trying to match into surgery, for instance, you don't match into surgery, and then the only spots available to you during the scramble process are like pediatrics in Alaska. Like that's obviously what you don't want to do, but at the end of the day, that's all that's left, and it's better than no job. So I did want to kind of touch on the stats from this year, 2022, because I think it's interesting and the match results were pretty good this year. So this is the 2022 residency match by the numbers that they put out at the end of the match every year. They haven't gone through the whole like breakdown by specialty. They usually do that usually like a year delayed, but this is what happened this year. So the total positions available were 39,205, which is up almost 3% this year from 2021, or up almost 1100 spots, which is crazy. You've seen on many of my other videos that the government is trying to increase residency spots, and it seems to be that they're doing a good job so far. Did I just say the government is doing a good job? And the total PGY1 positions filled, or intern year or first year residency was 36,277, and the discrepancy from that is because there are more positions than there are just first year positions alone. There's almost like a 3000 spot discrepancy between those two and that's why. So of those total positions, 36,943 were filled, which means there were 2,262 unfilled spots. And these unfilled positions are what people are doing after if they did not match on Monday. That's what you try to fill into that whole week during the match process. So here we have some other interesting stats here. So we have a percent of US MD seniors matched into PGY1 positions. That's 93% almost. And the US DO positions, that's matching at almost 91%. So pretty good results so far. We have increased residency spots, increased match rates, and so far so good. And while we're at it, let's touch on the interventional radiology spots because that's what I care about. And that was a very competitive match this year. So the interventional radiology stats where there were 168 positions offered and 100% of them were filled. Crazy? Well, not crazy because I figured they would all fill. There were 45 tatted ordinal positions and 246 applicants for those 45 positions. There still aren't that many positions in my field. There were 123 advanced positions for 300 applicants and 80% of those who matched were MDs and 13% were DOs. It was considered a top five competitive specialty this year, which is crazy. All right, so what do I think about this whole process? Well, for one, I just wanted to touch on this whole nonprofit NRMP organization that controls this whole match algorithm process because I think it's kind of interesting. So for one, the president of the residency match program for physicians is a nurse. And there's nothing wrong with nurses, but why is the president and CEO of the organization that provides residents or physicians with residency spots, not a physician? Weird, like they've never even been through the process themselves and they're the president and CEO running this whole nonprofit organization. And the reason I keep saying nonprofit is because of the financials. So this organization somehow takes in approximately 10 plus million dollars in revenue every single year. It was kind of crazy. So since it's a nonprofit organization, their tax information is released online, but I don't have the 2020 or 2021 tax year yet, but I do have 2019 and I just wanna show you all what your money is going to. So the total revenue for 2019 for the nonprofit organization was $10.7 million. That's right, $10.7 million for this nonprofit organization. Now, if you looked on the report, which I'll put up on the screen here, they have a nice pie chart and it shows how they kind of break down the expenses. And by category, the biggest expenses they have are salary, no surprise there, of $3.3 million in salary for that year and $3 million in information and technology, which I understand they have this big algorithm. They have all these computers working to make sure everybody matches into the appropriate program. But that still seems like a lot for a program that's been installed, installed for many years now. This isn't like a new program that they have to invent every single year. It's just an algorithm that they just use over and over again. It doesn't go bad. They probably need some maintenance every year, but it doesn't like get erased every year. So I don't really know what all of this money is going to. Maybe the website, I don't know. It seems a little weird to me. So again, $10.7 million in 2019. The total assets are $24 million of this company and the net assets minus liabilities are $19.5 million. This is a nonprofit company with $19.5 million in assets. Now I know this, you know, it's a nonprofit company and they can still have assets that's fine, but I just think it's interesting. And I also think it's interesting that med students are paying so much every single year, year after year to go to this nonprofit program. So the net income for 2019 was almost $2 million. And you can see right here that most of it went to the salaries of the executive board or the key employees of this program. So the president and CEO that is now retired in 2019 made $487,290 and the chief information officer, chief policy officer, senior director, they were all up close to $300,000 and it kind of goes down from there, but I'll put this up on the screen so you can see. And I just think it's interesting that a nonprofit organization is paying their executive so much money and these poor med students who have no money to begin with are paying for all of this. It's interesting. I just wanted to shed some light on it and open your eyes. And maybe we can date a little deeper on this once we have more information. So anyways, back to my thoughts on the whole match process. Well, for one, I think it's very expensive. I think it's a little too expensive because as you know, if you're a med student yourself, we are already exploited over the course of our med school, many fees, year after year, the tests, the board exams are expensive, the rotations are expensive, more board exams are expensive, the travel, all that kind of stuff, it really adds up, especially when you're just compiling all of this student debt and you don't have time to work. Give you a second look on where all these fees are headed, but I think there's a way to kind of cut costs for med students, especially when these nonprofit organizations are profiting well over $2 million every single year, all on the backs of these poor med students. Two, the match process is incredibly anxiety-provoking and I don't like that. I've been in those shoes before, I know how anxiety-provoking it is. I was very anxious myself, was I going to match into radiology, was I going to match into a program that I actually liked, was I going to end up 10th on my list, into some middle America spot with like five people in the town, you never know. And then once you finally find out that yes, you did match, you still don't know where you matched. And let's not even think about how anxiety-provoking it must be for those people who don't match, how stressful it is after working their butts off for four years and finding out you don't match. It's very stressful. And let's talk about another thing, the whole match party thing. Now I don't know, there are certain schools that do this huge match day celebration and they have envelopes for people. They come up one by one and you open your envelopes in front of the whole school and you say where you matched. But what if it's somewhere you don't wanna go or what if you don't match? You just have to do that in front of everybody? I don't know. You know what I'm talking about. I know all of you have seen these videos of the match days and how crazy it is and the cool celebrations, which is fine, but the whole opening up the letters in front of people when you don't really know what's gonna happen is you know, it's not the best. My third thought on the match process is unfortunately, I think it's probably necessary. The reason we started this whole process way back when is because we wanted to kind of streamline the process and get rid of the whole handshakes behind the scenes and limit the empty promises of program directors and med students promising program directors. It ultimately helps programs to make sure that their program doesn't go unfilled. It doesn't really help the med students as much as it does the programs. But at the end of the day, programs have to make sure they're getting their piece of the pie, AKA money from the government, AKA Medicare reimbursement for the residency spots. And unfortunately the med students are an afterthought. I honestly can't think of a better way. I sat here and thought about like, what would I do differently in this whole process? But to get rid of some of the behind the scenes handshaked stuff and empty promises, this is pretty much the only way. Now the algorithm could be run differently. You could do it quicker, obviously. You could limit the time between finding out if you matched and where you matched. All this stuff could be fixed. But ultimately, I think it's a necessary evil. Okay, so I know this video is getting kind of long. I just wanna say a big congrats to those that have matched. It's a huge accomplishment. Your official journey begins now. So if you liked this video, smash that like and subscribe button, follow me on Instagram and TikTok to be done already. And as always, I'll see you all on the next video. Bye.