When nearing the end of training a Medical Student takes Part 1 of the National Boards which then qualifies him to enter a lottery known as the Intern Matching Program. You pick a place or a city where you want to train, locate the accredited training programs available in the various hospitals, and then make up a ranked preference list, which goes into a central data bank. Conversely, the teaching hospitals get the lists and decide by rank which applicant they might want to take as an intern, usually based on the medical school he attended. After that the student gets a letter stating he has been accepted for an interview. No letter. No interview. No job.
Because so many students pick so many hospitals, the overlap leaves those hospitals not quite sure who will pick them at the end of the process. This forces the students to hedge their bets by over-booking interviews, like an airline overselling reserved seats, or the aforesaid Venn diagram of the double negative question. Interview, yes. Guaranteed pick by the candidate, no―and vice versa. Over a short period of time as the match progresses, the spots become progressively filled as increasingly limited spots become available. This is why foreign medical graduates tend to default to the second tier of community hospitals that do not have either good training programs or if they do, the programs are not accredited teaching programs. An ideal match is a Number One with a Number One plus a good interview; notwithstanding the usual politics and nepotism that goes with any such process.
In general, Harvard Hospitals choose Harvard Medical students, and so on and so forth across the country, not only because of effete arrogance but also because of the practical fact that any student applying to a system in which he is already a known entity obviates the risk of that teaching program becoming stuck with a potential loser. It is also the case that a teaching hospital will lean heavily toward a candidate if it has already had a good experience with someone else who trained at the same medical school. I had already decided I wanted to relocate to N.Y. City principally because I wanted easy access to my parent’s summer home for R&R, and so applied to about six major teaching hospitals in Manhattan. I got three interviews in return; Montefiore, Downstate and St. Luke’s Hospital. I received no answers at all from Columbia Presbyterian, New York University and New York Hospital Cornell; not even the courtesy of a polite “no, we don’t want you.”
Montefiore was the only hospital I received an interview with that was the central teaching center at a medical school, the Albert Einstein College of Medicine. The other three major teaching hospitals did not want to see me at all and the two that did were teaching hospitals closely affiliated with the major players, but not the primary or the elite hub. When I showed up at Montefiore, I knew immediately that I was in trouble. Every one of the twenty or so candidates that were batched for that day wore a Yarmulke, as was just about everyone else in the facility. In the preliminary phase before the one on one interview, we were made to introduce ourselves, then give a thirty-second personal introduction. As the names were called out: Silverman, Bernstein, Schwartz, Jason, Milliman, Saperstein; I knew my first name would hold some truck but that the last one would probably raise a few eyebrows. Being stupidly naïve, I had no clue that the institution was predominantly Jewish along with significant overlays of Jewish Orthodoxy. How was that for proactive thinking? Sign up for Albert Einstein and then be surprised that everyone there is Jewish.
When it was my turn I loudly stated Alan, and then softly mumbled my last name. The group leader shouted: “What? Say that again. Nobody heard you. What’s your last name?” With the cat now out of the bag when I loudly repeated my last name, you could hear a pin drop. This was followed by everyone turning their heads to stare with incredulous wonder at the interloping little guinea goy boy with a bona fide Jewish first name but without the funny little hat.
Passing on to the one on one interviews, I sat with a very pleasant physician who beside the usual queries wanted to know because I had a Jewish first name if my mother was Jewish and was that why I was here. I couldn’t lie, then told him no, to which he responded it really didn’t matter as he escorted me to the cafeteria for lunch. I figured there was no chance in hell I would be picked and that he was just being nice before the inevitable soft-landing rejection. At that point, even if I did think I could make a sincere effort to fit in, my hopes were dashed by the fact that all of the cafeteria food was pareve or kosher, making it so unrecognizable to my ordinary culinary tastes that on the food factor alone I knew I would never make it in this institution.
Imagine my shock then when I was taken aside at the end of the day and told that it was unusual for them to do this, but that if I agreed immediately I would be given an internship at Montefiore. They said I had interviewed well, that a few students from Tufts had passed through their training program from time to time, and that they had been so favorably impressed with their performances this legacy counted for very high marks in their overall assessment. Although I was sincerely flattered, I was leaning toward the jaded paranoid belief that I was going to be their affirmative action token Christian and told them I needed a day or so to think about it. It was chancy, because I had not yet heard back from St. Luke’s Hospital; which I had already decided on as a first choice. However, as luck would have it, within a day or two; I was, in fact, accepted there.
Having ultimately decided to reject the theory of religious relativity I went with the hospital named after the Patron Saint of Physicians and Surgeons. This was despite the institution, in an effort to be more pleasantly generic than hard core Christian, had adopted the venerable Saint’s mascot, a cow, to represent it’s symbolic logo; a little knock-off iconic version of the animal that bore an eerie resemblance to Bon Bel cheese company’s laughing cow: La vache qui rit. Except that this one has angel wings for ears.
Thank you very much. And I hope we passed the audition.