By sheer happenstance, I was visiting a surgery program on the day after “the Match.” As all of you know, four days before the official release of the placement of every new surgical trainee, both the medical students involved and the programs affected are informed as to whether they have been matched. Students don’t know where they are going, just that the last rung of training is now in place. They have a job and a relatively secure future. Those who have not been matched and those programs that did not fill all their slots now enter into a scramble (officially called SOAP) to find students for the remaining slots. This year, the scramble occurred on a Wednesday and was orchestrated by a set of rules I’d never been privy to before.

On Tuesday night, all the programs in need of students for their open slots, whether categorical or preliminary, looked over the list of candidates remaining and made their choices. So did the students now hoping to find a place. At 10 a.m., the offers went out to students in the first round. Next, in precisely timed order, the programs found out who had accepted the offers. And, if slots were left over, the programs had a short time to put up another set of offers – and so on throughout the day until all the slots were gone. Like a game of musical chairs, the music finally stopped and the Match was over for the entering class of residents for 2017.

I watched a program director as he made calls in hopes of finding slots for his trainees and waited to see what the scramble would bring into his program for the next year. I won’t violate the privacy of this good man’s thoughts, but I will offer up what went through my head as I heard the joy and sorrow playing out for young surgeons in waiting, hoping to pursue their dreams.

Ishan Patel shares the news of his residency match at OHSU's Match Day, March 17, 2017 in Portland.

Three days stand out as the essential moments in a surgical career. The first is the day a student gets word that he or she has been accepted by a medical school. The second is Match Day in the fourth year of medical school. The third is the day a young surgeon finds out the results of the certifying exam. Each of these days is a sine qua non in one’s career. For those who aspire to become independently practicing surgeons, no amount of dreaming or studying matters unless these challenges are successfully surmounted. No ticket, no show.

Lydia Michael (left) and her daughter, Ann Oluloro, celebrate Oluroro's residency match at OHSU's Match Day, March 17, 2017 in Portland.

Looking back on those three days, and reflecting on the drama of the Match with a program director, I was reminded of the intensity inherent in a career in medicine. For me, each of those days changed me in ways I couldn’t have predicted. The person I was sublimated into the person I would become. My future unfolded just a bit, allowing me to see four, then five, then 30 years into what might be. Because I had succeeded on those days, I honestly never considered the alternatives. As with any painful episode, I quickly forgot the fear of not getting those notices. It would take years for me to understand how profoundly being directed to a specific medical school, a specific program, and a specific specialty would define me professionally and personally. Those teachers and surgeons who became my mentors and role models taught me to think differently, to be empathetic, to protect myself from certain emotions, to cause me to “be like them” even though some of the original me remained. I am now the result of those three days.

Alissa Goodwin reacts in joy as she read her match at OHSU Match Day.

Not everyone who wants to be a surgeon gets to be a surgeon. With increasing numbers of medical school graduates but no increases in residency slots, the struggle to be matched may become even more competitive. Even very qualified people don’t necessarily get the letter, and we will never know what great contributions they might have made. Those of us who did “survive” those three momentous days owe it to the public and those whom we passed along the way to be our best in every way personally and professionally. Good luck to all those men and women who are about to find out what a life of surgery really is. You have been both good and lucky. May you add to the richness of this noble calling.

Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and coeditor of ACS Surgery News.

Three days in the life of a surgeon