Internships still existed when I was in medical school. An internship was akin to a tradesman’s apprenticeship. For one year after receiving my MD degree, I was assigned to a hospital of my choosing to get additional clinical experience. During my internship, I was the treating physician for patients assigned to me. I was supervised by an attending physician and his resident, and though I worked very hard, it was a very valuable experience.
Internships were not all the same. Private hospitals, city-county hospitals, and med schools all sponsored internships, and the type of educational experience you wanted determined which you chose. Grads planning to enter private practice usually chose private or city-county hospitals while those planning a career in academia or a surgical sub-specialty chose medical center programs.
The clinical (medical) focus of internships also varied. Mine was a rotating internship which “rotated” me through various specialties—peds, internal medicine, general surgery, emergency medicine and orthopedics (I was preparing for a career in orthopedic surgery). It exposed me to a variety of specialties.
There were also internships that focused on a specific medical area. These were called “straight internships”—straight medicine, straight surgery, straight anesthesia, straight OB-GYN. Every internship was required to have at least 2 months of internal medicine. Straight internships had medicine plus at least 2 to 10 months of the specialty of your choice. If you were planning a career in general surgery, a straight surgery internship was for you. If it was internal medicine, a straight medicine internship was best. After the intern year, graduate doctors in my era did one of three things: they began private practice, entered the armed forces, or started a 3 to 7 year residency program.
Today, internships don’t exist. Med school grads immediately begin a residency program so it’s helpful for them to have decided early on what specialty interests them. The process of internship and residency assignment was called the National Resident Matching Program (NRMP). Here, graduates and residency programs are matched with one another. Between my 3rd and 4th years, I visited hospitals in Indianapolis, Denver, Phoenix, and Albuquerque viewing their programs first hand. I knew doctors who were interning in each of these hospitals, and I wanted their opinions and input to help with my decision.
The intern program directors at each hospital interviewed me, and I carefully evaluated the pros and cons of each program. I ranked my top three choices and each program ranked me with their other applicants. This information was entered into the NRMP algorithm, and the matching process was on. On March 10, 1969, our class celebrated “match day,” the day my future career began.
“Match day” was a big deal! It was a pivotal day for all of us. The entire class had the day off, and we had a big celebration at the Slovenian National Hall in west Indianapolis. We performed silly skits, gave awards to some classmates, and recognized faculty members who were the best teachers. Many faculty members and administrators attended. After lunch, the big moment came. That was the time we all received notification of our “match” in an “envelope please” moment. I opened my envelope and was elated to read I matched with my first choice. I was headed to St. Joseph Hospital in Denver. Four of my classmates matched with St. Joe’s, too; five IU med school grads in the same intern program. I couldn’t have been more grateful and excited.
St. Joseph Hospital offered only rotating internships and filled all 18 positions available. For five doctors from the same med school class to be accepted at the same out-of-state hospital was unusual, but it meant I already knew four of my fellow interns.
The rest of match day was spent seeing who was going where, who got their first choice, and what specialty they had chosen. As I mentioned previously, a large number of my classmates were headed for internships in California, and were probably planning to remain there to practice. I went to Denver thinking I might want to live there for a long time and planning to have a career in orthopedic surgery. My internship provided me a varied experience which I was seeking and helped me make decisions important to the rest of my life. In the next blog, I will share specifics of this experience.
Addendum: The National Resident Matching Program was started in 1952. It is a private, non-profit, non-governmental program based in Washington, D.C. overseen by a board of directors. The board is comprised of medical school deans, teaching hospital executives, directors of graduate medical education programs, residents, medical students, and one public member. The program took a disorganized application process, simplified it, and added consistency that gave everyone an equal chance. Today, the residency match is used by 43,000 med school graduates, and by postgraduate physicians seeking sub-specialty training positions. Not everyone matches so those who don’t are enrolled in a program that connects them with residencies that have unfilled spots. Every graduate finds a slot that suits their educational interests.
