'ACADEMY AWARDS' FOR DOCTORS-TO-BE Envelope tells where they'll train next


One by one, with smiles and shaky hands, they grasped the white envelopes.

Many years of hard work had brought these medical school seniors to this moment. They had researched and interviewed at residency programs, then ranked where they wanted to train.

But yesterday, at noon Eastern time, when roughly 13,500 students from 126 medical schools around the country learned where they would be residents, gut feelings and rational thoughts were lost.

Some students had listed as many as 20 choices. And this was the piece of paper they had been waiting for, the single line of letters that spelled out where they will spend the next several years, the validation that they were really going to be doctors.

"It's strange to have the whole four years summed up into one envelope," said Dave Vroman, president of the University of Maryland School of Medicine Class of 1995.

Devised 43 years ago to stop the chaos of students and programs making selections before they could consider all their options, the National Resident Matching Program takes the ranked selections of students and residency programs and puts them through a computer system, which makes the matches.

Those students who haven't been matched are called two days before Match Day, on "Black Monday." The next day is the "Scramble," when deans try to find vacancies for their unmatched students.

Even for those who weren't called, the time is tense. They pretend it won't matter if they get third or fourth choices. Some have nightmares. Sanjay Jagannath, a University of Maryland student, dreamed that he had been matched to a prison, to be the inmates' physician.

At the Johns Hopkins University School of Medicine, the family of Jenny Walser -- all medical professionals -- measured her excitement clinically.

"We've been taking her pulse all morning and it keeps rising," said her father, Dr. Mackenzie Walser, a professor of medicine at Hopkins.

"Oh my God, it's up to 120," said Ms. Walser, her fingers pressed to her wrist, just before the envelopes arrived. "I'm going to die and never know where I got my residency."

She will train in internal medicine at Massachusetts General Hospital in Boston, her first choice.

Yesterday morning, Tracey and George Hoke, a husband-wife team of physicians-to-be at the University of Maryland, woke up at dawn.

"We looked at each other and thought, 'What will it be?' " said Tracey Hoke. She and her husband applied as a couple, meaning they would be placed at the same institution. They also wanted to be close to Maryland and their families.

They waited until each had received an envelope and then, together, ripped them open. "Oh my God," Mrs. Hoke said, smiling and crying. She slapped her husband's hand in a high-five and hugged him, hanging onto him for a long moment.

Then she stood up to call to waiting family members in the back of historic Davidge Hall.

"Virginia!" Mrs. Hoke shouted.

For nearly an hour at Davidge Hall and in the Tilghman Room at Hopkins, there were hugs and shrieks.

Mr. Jagannath tore into his envelope immediately. Jumping and screaming, he picked up Mrs. Hoke and twirled her around.

"It's awesome. I never even thought I would get in there," said Mr. Jagannath, 25. Out of 14 choices, he got his first pick: internal medicine at the University of Colorado Health Sciences Center in Denver.

At Hopkins, Trevor Myers, 26, got his top wish, an anesthesiology residency at Boston's Brigham and Women's Hospital. "I'm floating so high I could take Shaquille O'Neal," Mr. Myers said.

Not everyone was so vocal. At Maryland, Lauren Cobbs, 25, sat down with her envelope, quietly opening it. Her eyes widened a little.

"It's like at the Academy Awards, I swear to God," Ms. Cobbs whispered, staring at the paper that read University of Maryland, where she will study internal medicine -- her first choice. "I'd like to thank people."

A few rows away, John Moriarty's hands shook as he tried to open his envelope. Friends crowded in on him. He was sweating. After a long pause, he said one word: "Yale."

Like Mr. Moriarty, most of the local medical students got one of their top picks. At Maryland, 51 percent got their first choice, and 76 percent got one of their top three picks. At Hopkins, 70 percent got their top choice, and 90 percent got one of their first three choices.

From a national perspective, the news was also good. For the first time in seven years, more than 50 percent of fourth-year students at U.S. medical schools signed on to train in generalist fields -- family practice, internal medicine or pediatrics -- where the need is greatest. Also, the highest number ever will study family practice -- about 2,081, or 15.4 percent of the 13,500 students -- a 12 percent increase from 1994.

"The change is very significant," said Dr. Patrick Harr, chairman of the board of the American Academy of Family Practice.Increasing use of managed care and better reimbursement for primary care doctors has helped spur the change. In the last four years, about 500 new family practice residencies have opened up.

Experts said the numbers are a sign that some progress has been made in turning around the current situation -- 30 percent generalists and 70 percent specialists.

But yesterday, statistics meant little.

Andrea Maynard, 26, in her final year at Hopkins, will be off to Seattle to begin her pediatric training at Children's Hospital.

"Oh my God!" she said. "What an amazing, incredible feeling when you finally get what you've worked for for 10 years."

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