Rachael Haines spent nearly 30 years preparing to be a doctor. 

Her husband’s military contract made medical school unfeasible, so in the interim, Haines graduated from college, raised four sons, and launched a career in nutrition and fitness. 

Piecemeal, she worked toward the dream: taking prerequisites here and there and studying for the MCAT, the medical school entrance exam, while her sons were in school. Then, four years ago, at age 45, she enrolled at The University of North Texas Health Science Center’s Texas College of Osteopathic Medicine. 

Her journey culminated Friday, March 17, during Match Day, a ceremony held at medical schools across the country where students discover where they’ll pursue residency for the next three to seven years. Haines, who’s now 49, is the oldest member of her class. She matched in family medicine with McKay-Dee Hospital in Ogden, Utah. 

Her 209 peers also matched. Across town, 52 medical students at the Burnett School of Medicine at TCU did so, too. Both schools reached a 100% match rate. 

For some, like Haines, Match is a wellspring of emotion — the exhausting, relieving, sometimes bittersweet endpoint after years of toil, and the marker of more to come. 

The Fort Worth Report outlines the journey of the Match process, which begins informally in a medical student’s first year and swells to a crescendo of applications, interviews and decisions during their fourth.

The largest Match in the program’s history

The Match process first paired students and programs in 1952, after years of mayhem

Competition among hospitals had led to increasingly early offers to students, sometimes in the beginning of their third year. The approach required students and programs to make decisions without knowing much about each other or their options. 

The resulting clearinghouse, which would eventually become the National Resident Matching Program, matched over 5,500 students with residency slots left over that first year. Just over 70 years later, nearly 43,000 applicants vied for close to 40,400 positions — the largest Match in the program’s history, according to the program’s website

For students, the Match is the end result of years of effort. Akin to the college application process, Match requires a maelstrom of paperwork, including transcripts, letters of recommendation, test scores, resumes and personal statements. Interviews and site visits follow, culminating in the spring with a pairing of applicants to programs. 

Nationwide, most medical students learn where they matched the morning of the third Friday in March. 

‘I think the time is right now’

Haines and her husband met in college, at a dance in Utah. After they married, he joined the Air Force and they moved around: First to Texas, then to Oklahoma, Washington, Hawaii, Ohio, Virginia and back to Oklahoma. Along the way, their family grew: They had four children, all boys. 

Haines, who studied dietetics in college, worked part time as a dietitian and fitness instructor. Her husband traveled often, sometimes weeks at a time. Most days, the care of their home and sons fell to her. 

 “It was a good opportunity for me to be with my children,” she said. And when the time came for her husband to retire, she knew her turn had come.

Haines had long been fascinated by the body. In middle and high school, to the chagrin of her peers, she went on runs and ate sprouts, yogurt and whole grains for lunch. “This was way back in the ’80s,” she said, “Now it’s like a thing.” 

Behind her efforts was an itch to become a physician and help people heal. No one in her family had pursued that path, and when the babies and the moves came, she wasn’t sure she would, either. 

Over time, she made choices that kept the door open: About 2010, when they were living in Ohio, she took her chemistry prerequisites. Then, beginning in 2017, in Oklahoma, she took physics. When her husband told her he planned to retire, she was ready. “I said, ‘OK. I think the time is right now,’” she remembers. 

She warned they might have to move — for medical school, then residency, then a job.

“He said, ‘You’ve done that for me for the last 21 years,’” she said. “‘I can do that for you.’”

Shaping the Match application begins in year one

When a sea of new medical students rolls in each July, Melva Landrum knows most newcomers’ end goal: To become a fully licensed physician. For that, they’ll need residency.

Landrum directs the Medical Student Success Team at the Texas College of Osteopathic Medicine. Beginning in year one, she and her colleagues guide students in shaping their applications for Match. 

The first step, Landrum said, is helping students know themselves.

During orientation, her team guides the incoming class through a values workshop, which encourages students to look within: Do they value patient relationships? Work-life balance? Working with children? The answers can help narrow down a specialty.

The most competitive applicants begin exploring that specialty early, whether through a short-term shadowing experience with mentor physicians, volunteering, attending conferences or seeking leadership positions in medical organizations.

Along the way, the Medical Student Success Team scaffolds the journey. Each student is paired with a residency counselor, and the team hosts roughly a dozen application workshops in the summer between the students’ third and fourth year. 

Finally, Landrum leads students through an interviewing class, a mandatory, semester-long course they take in the fall of fourth year.

“I try to set the standard to say, ‘You are among brilliant, bright, high-achieving medical students who have the same goals that you have.’ The playing field is level, but it’s high,” she said. “So you really have to look at ways to say, what’s going to distinguish me from other medical students?”

Still, Landrum discourages students from trying to “fit into a box,” she said. “I thought it was really interesting how much coaching I had to do to say, ‘Just be yourself.’”

Sizing each other up

For Haines, family medicine felt like a natural fit. The specialty, a form of primary care that treats babies to seniors, is holistic and preventive, a nod to Haines’ commitment as a teen to healthy living.

Last year, she also enrolled in a certificate program in functional medicine, a model of care that harnesses skills like meditation, stress management and diet to help ease inflammation in the body. “I’m absolutely loving it,” Haines said. “It’s awesome — all the stuff that’s right up my alley.”

Medical students traditionally begin to explore and narrow down specialties during their third-year clinical rotations, weeks-long blocks where they train in hospitals and clinics. The rotations continue during fourth year, with an added pressure: Students can pursue “sub-internships,” or audition rotations, in which they work within a residency program they’re eyeing. Haines completed multiple audition rotations in North Texas and one in South Carolina. 

As she learned about each program through research and observation, she gathered her notes in Notion, a productivity tool she began using during third year. Back then, Landrum encouraged students to spend at least two hours a week researching residencies; Haines did so religiously. 

At the same time, residency programs work to recruit students. Glossy websites boast program benefits, student interviews and unique curriculums to draw in people like Haines. 

For programs in primary care, the need is urgent: The Association of American Medical Colleges predicts a nationwide shortage of tens of thousands of primary care physicians in the next decade.

That meant Haines had options. She applied to 22 programs in the fall of her fourth year. Twenty-one invited her to interview, and she accepted 15 — a mix of in-person and Zoom, which she scheduled throughout her clinical rotations. 

In the interviews, the programs asked questions like “tell me about a time you’ve had a conflict with a colleague and how you handled it,” and “tell me about a time where you recognized you had bias toward a patient.” 

For the latter, she shared about a woman with Crohn’s disease. When Haines entered the patient room, she sensed the woman had been smoking, a behavior that worsens the disease’s course. 

Haines felt a tendril of judgment, then let it go. The patient had lived through myriad traumas. She shared them with Haines, and a relationship formed. 

“When I put aside that initial judgment,” Haines said, “I felt a love for her and an admiration for what she had gone through in her life and where she was.”

Ranking the programs

The online Match system asks applicants to list their residency preferences in order. Meanwhile, residency programs rank their preferred candidates. An algorithm creates the final match.

YouTube video

Following Landrum’s advice, Haines ranked all 15 of the programs she interviewed with. 

Her husband, an “Excel wizard,” made her a spreadsheet so she could arrange possibilities by columns and rows. In it, she listed her priorities, which her husband weighted, then calculated a final score for each program.

After that, Haines did what felt right — tweaking the list here and there, especially at the top, until she settled on her No. 1: the Mountain Area Health Education Center in Asheville, North Carolina. She’d been captivated by the landscape and the program’s offerings, including the option to concentrate in lifestyle medicine.

‘I will try my best to bloom where I am planted’  

The emails came two minutes before 9 a.m. Monday morning, flooding tens of thousands of inboxes with ‘Congratulations, you have matched!’ or, for some, ‘We are sorry, you did not match to any position.’

Haines had woken early, as was her custom, to siphon through practice questions. Her third board exam would come for her during her first year of residency, a hurdle she couldn’t ignore amid the day’s more pressing uncertainties.

When she opened the email, relief came. She’d matched.

What happens to students who don’t initially match?

Students who don’t match participate in SOAP, the Supplemental Offer and Acceptance Program. SOAP requires resubmitted applications and speed dating-style interviews between unmatched students and residency programs with unfilled spots​​.

On Friday, Match Day, Haines arrived with family in tow: Her youngest son, Ben, and her mom and aunt, who both flew in from Utah. Earlier that day, her husband, now a pilot, texted in from Alaska. 

They huddled together toward the back of Dickie’s Arena Pavilion, surrounded by friends, families and medical students awaiting word of their Match. 

Throughout the U.S., students receive official placement emails at 11 a.m. Central on Match Day, the third Friday in March. At the Texas College of Osteopathic Medicine, the letter-opening ceremony took place an hour early, a chance for students to receive the news in concert with the people who helped them along the way.

When the customary countdown began, Haines stood with her son, envelope in hand.

There’s a moment after the countdown, a collective inhale as letters unfold and eyes adjust to text, before screams of surprise and joy erupt in pockets around the room. Haines read the letter and looked at her mom. “Ogden!?”

Haines’ mom began to cry. She’d wanted her daughter back in Utah.

Rachael Haines, left, hugs her mom, Arlaine Austin, who lives in Utah. Moments before, Haines learned she’d matched at a family medicine residency in Utah at Match Day on Friday, March 17, 2023. (Alexis Allison | Fort Worth Report)

As for Haines, the news is bittersweet. She didn’t match with her top program, but stayed within her top five. And, she’s thankful to be near the mountains again, to study rural medicine, to be near family. “When I saw the emotion burst out of my mom when she heard that I was coming to Utah,” she reflected later, “I realized how much she wanted me there.”

In the coming days, Haines will have much to do, like sell her house. And school goes on: This week, she’s camping in the woods as part of her wilderness medicine rotation. 

She graduates in May, and her residency begins in July. 

“I also trust in God that I am going to the right place,” she said. “Just like the many previous moves I made in the military, I will try my best to bloom where I am planted.”  

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her at alexis.allison@fortworthreport.org or via Twitter.

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....