Thread by @ilanarosman

The last few days on #medtwitter have been difficult. Seeing so many happy "I matched!" emails interspersed with devastating news of not matching makes you question the entire system. And there's reason to. There are a lot of problems, and not very easy solutions. A few here...1/

Medical training is too expensive – in time, tuition, & opportunity costs. This makes Match Day the ultimate high-stakes situation. The costs of not matching are unfathomable. 2/

The costs of higher education in this country must be addressed. Professional & graduate degrees should not be reserved for the privileged. Certain specialties should not be available based on socioeconomic class, race/ethnicity, or background. 3/

Med students spend nearly a year managing the application process ➡️ wasted 4th year. Restructuring to allow more flexibility, particularly given the move toward competency-based #meded, is possible & would mitigate some of the challenges associated w the current process. 4/

There is too much focus on specialty choice. Let me be clear – there is no “soulmate” specialty. Yes, you will gravitate toward some specialties more than others, but there is not one perfect specialty for each person. 5/

Like there’s no dream specialty, there’s no such thing as a dream job. Over time, you will (hopefully) have the ability to craft & re-craft your job many times. As a student, you may have a clear idea of what this looks like or you may not have the foggiest. Either is okay. 6/

You’re starting a decades-long career. It will change over time based on your interests, personal & professional circumstances, & just plain chaos of the world around you. To think that as a medical student, everyone should know exactly what their path will look like is crazy. 7/

The focus on specialty choice makes Match Day all the more challenging as students put all efforts into convincing programs that it is “insert specialty here” or bust (because they feel they have to in order to match). This approach hurts students & our entire medical system. 8/

Don’t match? You see no option other than trying again & again (losing more $, more time, more of your self).

Match? You've made it!…but reality may not live up to your idea of that specialty (often based on limited rotations @ academic medical center).

Hello, burnout. 9/

(To be clear, for medical students: none of this is your fault. The system has created circumstances that make it virtually impossible for you to not put all your eggs in one specialty basket.) 10/

Being a doctor is more than a specialty. Training should allow students to explore elements of a career in medicine to determine what’s most important to them: a specific patient population, disease process, inquiry & research, innovation, education, advocacy, patient care...11/

Specialty choice should come later and students should be encouraged to (or at least not discouraged from) choose multiple specialties. Why is dual applying seen as a negative? There are no “back-ups” but rather multiple options for a thriving career. 12/

Yes, I know that more students dual-applying would jam up the process even further. Of course, that’s why we need to continue down the path of reforming the application process. Application caps, interview caps, signaling, etc. can all help. 13/

We need to re-imagine the #meded process from start to finish. What does a continuous process based on competency look like? What does gaining general experience before choosing a specialty look like? How can we make the application process more compassionate & effective? 14/

I don’t have answers to all of these questions, but there are a lot of people tackling these questions and more from multiple angles. That gives me hope. 15/

If you matched this week, congratulations! If you didn't match this week, I'm so sorry. Know that everyone who applied - no matter the outcome - worked hard to get here and has much to offer their future field and community. x

PS For those who say "easy for you to say, you're a dermatologist," the truth: some days, I ❤️ #derm #dermpath...others, not so much. More important to me: working w students & trainees, helping others - I would've been happy doing that in many other specialties, no question.