At Match Day, it's a family (medicine) affair

Norbert von der Groeben

Sarah Bahm shows off her envelope at Match Day. She will be doing a residency in pediatric neurology at Stanford.

Today, just before 9 a.m., Danica Lomeli, 28, a soon-to-be MD, stood huddled with a crowd of family members, waiting to open the white envelope gripped in her shaking hands. Her mom, dad, brother, cousins and best friend glanced curiously at the envelope that would play an important role in shaping Lomeli's future — the result of years of hard work and sacrifice in her quest to become a family doctor.

"I vividly remember a beautiful spring day years ago in Baltimore when I went through this," said Eric Sibley, MD, PhD, the faculty adviser handing out this year's Match Day envelopes, Academy Awards-style, in a room filled with Stanford medical students anxiously awaiting the news of where they would be spending the next four to seven years of their lives as medical residents.

"You may now open the envelopes," Sibley said at exactly 9 a.m., after all the students had been handed a white envelope with their names printed on the outside.

And the tearing began.

Lomeli and 90 other Stanford graduating medical students had gathered at the Li Ka Shing Center for Learning and Knowledge at the same time as thousands of other medical students across the country for the annual celebration that occurs each March. Along with family, friends and faculty, the students arrived in dresses and heels, suits and ties — some with babies and proud parents in tow — to learn their future. Nearby, champagne glasses sat waiting.

The tradition is both an exciting and somewhat stressful affair, with the residency assignments ultimately determined by a nonprofit organization, the National Resident Matching Program. The group uses a computer algorithm to align the choices of the applicants with those of the residency programs.

Norbert von der Groeben

Danica Lomeli hugs her father, Luis, while her mother, Diana, reacts to the news that Danica will be doing her residency at UCLA in family medicine.

"I couldn't believe they did it this way," said Leah Newman, whose boyfriend, Nico Grundmann — an almost-graduate of Stanford's MD and MBA programs — was hoping to match in either Oakland or Brooklyn, NY, in emergency medicine. Nerves kept them both somewhat sleepless the night before. (Soon they'd find out they'd be making New York their home.)

"It's very strange not to know until you get the envelope," Grundmann said.

At about 8:30 a.m., Charles Prober, MD, senior associate dean for medical education, addressed the group, teasing them with snippets of information about the results to come.

"It was a spectacular match this year," Prober said. This year's class was particularly successful, with all 91 students matching, 70 percent receiving their first choice and 85 percent one of their top three choices. Students matched in 15 different states, with two-thirds divided between Massachusetts and California. Nineteen matched with Stanford residencies.

"It was also somewhat unique in that almost half matched in an area of general medicine — pediatrics, general surgery, ob/gyn," Prober said. "Eight students are going into family medicine. (The annual average at Stanford since 2007 has been just two to three.) Each of them are very interested in changing the way medicine is practiced in the U.S. from the grassroots level up."

Norbert von der Groeben

Raymond Tsai chats with Erika Schillinger, a clinical associate professor of medicine. Tsai will be doing his residency at UCLA in family medicine.

Prober was referring to a new and growing emphasis on primary care within the medical field as a whole, spurred by a variety of factors, including a nationwide shortage of primary care physicians, the Affordable Care Act leading to millions of newly insured patients and the crisis of burgeoning health-care costs. Through the new health-care law, the federal government has increased financial incentives to make training in primary care, which traditionally pays significantly less than specialty medicine, more attractive.

"The writing is all over the wall that we as a country need primary care, and family medicine is really where most primary care doctors come," said Erika Schillinger, MD, clinical associate professor of medicine and director of predoctoral education for family medicine, who was thrilled that eight students matched in family medicine this year.

"Medical students come to Stanford wanting to be leaders and innovators," Schillinger said. "I see lots of exciting things happening in family medicine, and these are the kids who can do it. Stanford has traditionally been known for graduating leaders in research. There is lots of room for research in primary care delivery. There is no end of questions to be asked and answered, particularly around health-care delivery in communities."

Norbert von der Groeben

Soon-to-be graduates of the School of Medicine gather on the steps of the Li Ka Shing Center after the Match Day ceremony.

Lomeli and a friend and fellow student, Raymond Tsai, are both good examples of students who hope to work in family medicine and within communities as front-line physicians and leaders in research.

"I'm excited about the future of medicine, about my role as a family physician," said Tsai. [He wrote about his hopes for the future in this item on the Scope blog.] "I think everyone is intuitively looking at primary care for answers, particularly for prevention of chronic illness. It's time to deliver on that promise."

But first, there were the envelopes to be opened.

For Lomeli and Tsai, those envelopes held good news. Each matched in family medicine at  UCLA Medical Center, Santa Monica — the first choice for both of them.

Lomeli thrust her opened envelope high into the air and yelled, "It's UCLA Santa Monica!" Then jumped into her dad's arms. Her father, Luis Lomeli, who grew up in a housing project in Compton after immigrating to the United States from Mexico at the age of 14, is a UCLA grad and family physician who has dedicated his life to caring for the working poor and uninsured. And he's Lomeli's role model.

"The future of medicine is to have people like Danica comprehensively treating the patient and controlling costs," he said, smiling at his daughter proudly. "Medicine needs to change for the benefit of the patient."

At the same time, the entire room burst into applause, and tears and screams, as all the envelopes were opened. Medical students hugged parents and children, cameras flashed, cell phones lit up. And, finally, the crowd headed out to the lobby, where the champagne glasses stood ready.