Nikki Alworth stared at the envelope, then stared again, her eyes scanning the words over and over.
She wasn't imagining things. The University of Maryland medical student would remain at the university to begin her career as a doctor in emergency medicine. No need to sell the house in Rodgers Forge. No need for her husband to find a new job and to hunt for new day care for their 18-month-old daughter, Finley. And no need to fret any longer - she got her first choice.
With the uncertainty of health care changes and a shortage of primary-care physicians hanging over their profession, Alworth and the more than 16,000 seniors at 130 medical schools across the nation had a lot to consider Thursday as they simultaneously ripped open "Match Day" letters, notifying them of where they'll spend their postgraduate training. Nearly 300 of those students opened their envelopes at the medical schools of the University of Maryland and the Johns Hopkins University in Baltimore.
Those who matched across the country included several students who will spend the next six years as the first residents in a new urban health program at Hopkins, managing the medical problems of the poor.
While some students pondered the future of their profession, for many, the letters foretold the paths their personal lives will take over the next few years - whether they would move or stay in place, join a significant other or be separated, pursue a dream or settle for something less.
"I've been shaking and sweating and preparing for the worst," said Alworth, 30, beaming. "I still don't think this has hit me."
Tears came to her eyes as she opened her letter, relieved at the prospect of staying home, but also invigorated at the opportunity to practice at a top-notch program. It was quite a personal accomplishment, she said, after juggling a toddler and medical school's punishing schedule. "It's been extremely challenging, and we've made huge sacrifices in our personal lives over the years," Alworth said. "And it was all to achieve this one goal."
The 58-year-old Match Day program is designed as a fair way to assign medical school seniors to their residencies, which can last from three to seven years. Seniors pick their specialties, interview at programs and make lists of where they would like to train. The programs scrutinize applicants and make their picks to fill openings. A computer matches program with applicant after evaluating the preferences of each.
At the University of Maryland's 198-year-old Davidge Hall, the annual ritual was steeped in tradition, suspense and plenty of drama. Crammed into the round auditorium, students and their families cheered as the names of 161 students were called one by one. Before accepting their envelopes, each student placed $5 into a gold shopping bag, with the last to be called receiving the jackpot.
Some walked quietly back to their families and opened their letters with a shriek, a shy smile or tears. Others remained at the podium and pronounced their match aloud, to the whoops of approval from classmates.
"Oh my God, I'm shaking," said Marie-Rose Alam, 26, as she posed for a photo with her match letter in hand, noting a residency in psychiatry at Georgetown University. "It's scary when you don't know what's going to happen. I'm just excited to finally be in the field that I studied so hard for."
Similarly, across town at Hopkins, the excitement filled the common area of the Armstrong Medical Education Building as students shared a hearty champagne toast, then counted down to the unveiling of folded, sealed papers. Upon opening the documents, many students let out loud screams of joy, and there were hugs all around. Some posed with fellow students, holding up their papers to cameras.
The school's new urban health residency program aims to create leaders in primary care fields trained to tackle problems such as diabetes, alcoholism and domestic violence.
Hopkins student Paul Doherty, 33, of Waynesboro, Va., was among the four residents named to the program, having spent eight years before medical school helping to get treatment for HIV/AIDS patients, drug addicts and the homeless.
He said his drive to enter the urban health residency came in part after he met a woman in the D.C. area affected with AIDS. He helped her acquire Medicaid and Social Security for receiving proper treatment, and then she went from skeletal, feeble and unemployed to healthy and capable enough to rejoin the working world.
"That was so amazing to see that," said Doherty. "It helped me to realize how important good medical care can be in transforming people's lives."
Asked if the prospect of health care changes reform and the shortage of physicians affected his decision, Doherty said: "Before this debate really got started, lots of people believed that there aren't enough primary-care doctors. I definitely felt there particularly aren't enough very smart, capable people who can choose to do anything they want who make the choice to make primary care. That's important."
Dr. Richard Colgan, director of medical student education in family medicine at the University of Maryland, said he was encouraged by the increase of students going into primary-care specialties - 37 percent at Maryland, up from 32 percent last year. If health reform passes, more primary-care doctors will be needed for the newly insured, especially in Maryland, he said.
Still, Colgan didn't expect that students were too concerned about the political wranglings over a health bill. They just want to be good doctors, he said.
"The health care reform stuff is about money," he said. "But they're not concerned about their socioeconomic lives. They're more concerned about the lives of patients. This is a very altruistic group. They love patients, and they love serving others."
With that goal in mind, students were preparing to serve at home as well as abroad. Hopkins student Brian Englum, 29, will serve his general surgery residency at Duke and said he hopes to take part in the school's new foreign initiative.
As a Peace Corps volunteer, Englum performed services in Benin, West Africa, in villages in need of better sanitation, HIV/AIDS education and health care for mothers and babies. He performed similar duties in the Congo.
"I have had the chance to go to the Congo during my time here," he said. "I've had the chance to work with a number of different people in different specialties. I think that wide range of opportunities gives you the tools you need to go into a specialty where you're going to be dealing with anything and everything that comes through the door."
Back at Maryland, Janelle Cooper, 28, of Mitchellville had just returned from a monthlong trip to Cape Town, South Africa, where she worked with HIV patients. But she said she was looking forward to treating women in her own backyard, having matched at Washington Hospital Center in a residency in obstetrics and gynecology.
"All of the hard work of medical school has led to this day," said Cooper. "I'm looking forward to being called 'doctor.' "
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