Dr. Ricardo Albarran-Anguiano was in the throes of applying to residency programs last spring when he received the gift basket: a bundle of goods reminiscent of Fort Worth, including a jar of Mrs. Renfro’s salsa.
Every medical student who’d earned an interview with the internal medicine residency received one, according to Michael Sanborn, president of Baylor Scott & White All Saints Medical Center – Fort Worth. The program, a collaboration between the hospital and the TCU School of Medicine, was seeking its inaugural class of residents and wanted to make them feel welcome.
The salsa helped. For Albarran-Anguiano, who went to medical school in Arkansas, the gesture was a friendly touch — a display of recognition and encouragement amid a trying season for medical students. When Match Day rolled around in March 2021, Albarran-Anguiano received good news: He and the Baylor Scott & White program had chosen each other.
For medical students, Match Day — the day medical students nationwide find out where they’ll train next — is a culmination of ceremony and sweat, a sometimes bittersweet midpoint along what is usually a seven-or-more-year journey. For residency programs, it’s an annual opportunity to make headway against the nation’s growing physician shortage. And for Fort Worth, it’s a precursor to sharpened standards of care in area hospitals, a first step toward drawing physicians like Albarran-Anguiano to remain in the area long term. He’s planning on it.
“(Residency programs) open doors for you when you need them most,” Albarran-Anguiano said. “So I see it fit that, if they train me, I should pay it back — and hopefully do the same for somebody else coming along.”
How Match Week works
When Albarran-Anguiano learned he’d matched last year, he did so quietly, with little fanfare. He’d purposefully stepped away from his family in Arkansas to savor the knowledge.
“We go through so much rigorous education and training that I felt like I owed it to myself to cherish this moment on my own,” he said.
Match Day — March 18 this year — takes place annually on the third Friday in March, but Match Week starts the Monday before at 8 a.m. Central, when students receive an email to let them know whether or not they were accepted into a residency program. However, they won’t know where they’re going until 11 a.m. on Friday.
Students who don’t match get shuffled into the hurly-burly of SOAP, the Supplemental Offer and Acceptance Program. SOAP requires three days of resubmitted applications and “speed dating”-style interviews between unmatched students and residency programs with leftover spots, said Dr. Hilary Ryder, a physician and director of the newly formed internal medicine residency program at Texas Health Harris Methodist Hospital Fort Worth, another collaboration with the TCU School of Medicine.
That’s when the career counseling department, a.k.a. “battle team,” at the Texas College of Osteopathic Medicine steps in, according to Rynn Ziller, the school’s assistant dean of medical student success. If you were to enter the department’s “war room” at any given moment during Match Week, you’d find team members in every corner helping medical students who didn’t match with personal statements, applications and counseling. “They work their fingers to the bone,” Ziller said.
She’s confident that, by Friday, all of the unmatched students at Fort Worth’s osteopathic medical school will have a match.
The process, however, isn’t a guarantee. The number of residency spots has not kept pace with the number of applicants, according to a 2021 report from the National Resident Matching Program, which facilitates the Match.
The discrepancy further complicates a physician shortage caused in part by an aging population of Boomers who both need care and whose physicians have begun to retire, Sanborn, with Baylor Scott & White, said.
“Ultimately what we’re trying to do is improve the physician supply in Fort Worth,” he said, “but also do what we can to address the gap.”
‘Like a rocket ship taking off’
Albarran-Anguiano is an old hand at new programs. As a medical student, he was in the first class to graduate from the newly minted Arkansas College of Osteopathic Medicine. And last year, he joined the inaugural cohort of Baylor Scott & White’s internal medicine residency program.
The exponential growth he’s observed in the latter program is “almost like a rocket ship taking off,” he said.
Establishing a residency program takes time, talent and money. The Accreditation Council for Graduate Medical Education, the accrediting body for all residency programs in the U.S., requires programs to fulfill dozens of pages of requirements that govern everything from the appointment of a director to the provision of a lactation room for residents who breastfeed. Further requirements exist for each specialty.
The requirements can take a toll on a hospital’s checkbook. Nationally, each resident costs the program around $150,000 per year, Sanborn said, around $65,000 of which serves as salary and benefits for the resident. Other expenses cover physician faculty who train the residents, as well as support staff. A single program can cost a hospital millions of dollars each year. “That’s a pretty big hurdle,” Sanborn said.
Government funds provide roughly 80% of the costs, he added, but the program absorbs the rest: “That’s part of the reason why every hospital doesn’t have a residency program.” For Baylor Scott & White, a nonprofit health system, the Fort Worth community donated millions to cover some of the infrastructure needed for the residents.
In turn, the program will benefit the community, Sanborn said.
Because teaching hospitals, or hospitals with residency programs, require their medical staff to keep abreast of cutting-edge medical research, a residency program “improves the overall level of care that hospitals provide,” he said.
Furthermore, physicians tend to stay near where they attend residency. Nearly 70% of physicians who completed residency in Texas remain in Texas to practice.
“Opening up more residency programs does enable us to increase that pipeline,” said Ryder, with Texas Health.
Internal medicine as a foundation
When Baylor Scott & White and Texas Health were deciding which programs to pursue, they both analyzed the local health care landscape.
The internal medicine program at Baylor Scott & White is meant to be “complementary” to other programs in north Texas, Sanborn said. For example, “we intentionally did not do family medicine, because (JPS Health Network) has a very large and highly successful family medicine program.”
Internal medicine, a form of primary care, provides the foundation for specialties like cardiology or oncology. After he completes his residency program, Albarran-Anguiano intends to pursue a fellowship in gastroenterology, the branch of medicine that cares for the digestive system.
“Internal medicine is really important here, certainly in Fort Worth, but also for all of the other fellowship programs that are in and around north Texas training all of those specialty physicians as well,” Sanborn said.
While Baylor Scott & White’s inaugural internal medicine residency program began in 2021, the internal residency program at Texas Health Fort Worth will receive its first cohort this year. The program will center a commitment to serving people who are traditionally underserved, as well as physician well being, among other values.
“We really want our residents to be able to sustain the meaningfulness of the work they do and be able to find joy and satisfaction in our work over the course of their lives,” Ryder said.
She’s hoping the residents will choose, ultimately, to practice in Fort Worth.“‘Train to retain’ is the slogan that I’m using,” she said.
That pursuit continues on Match Day. After the ceremony, she’ll call the 10 students who will be joining her program in July to “welcome them to the family.”
As for Albarran-Anguiano, he’ll be waiting in the wings this week, ready to celebrate the new cohort of internal medicine residents in his program — and pay forward the “home support” he received at this time last year.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.