Match season begins innocently enough, but for a raging sense of insecurity. The first step is deciding the number and location of programs to which to apply. Geographical preferences usually weigh heavily in the decision, and several initial top choices are selected.

But then, like an insidious and heavy creeping fog, comes the thought, “What if it isn’t enough? Which programs will like my application? What if none of them does?”

According to mentors and family, things have really changed in the match. It used to be that applying to several programs was enough. Now, we are being told by advisors that we should apply to around 35 programs. (And if not “competitive,” even more.)

The goal is to interview at 10-15 programs so that one can have the “mean number of ranks associated with a successful match,” which is 10. For most people I know, 10 is a minimum, and there is a great deal of anxiety associated with not having this number of interviews. Interviewing at 20 programs, all around the country, is not at all unusual. If you are pursuing “couples matching,” multiply all of the numbers above by two or more. It’s out of control.

Some programs begin screening applications immediately. Many of the interview slots are already filled by the time the dean’s letter comes out. Other programs will not look at any applications until they are complete.

As an applicant, you want your file at the top of the heap, so getting everything in at the earliest possible time is crucial. This means hounding letter writers and perfecting the personal statement at a very busy time. All of this is happening during board exams and subinternships. It also means that any obsessive-compulsive tendencies and type-A behaviors roar into gear.

Most applicants are starved for information about when interview invitations are going out and to whom. This allows one to gauge how competitive one’s application is. If things look good, it is an ego booster; if they look bad, it is surely quite distressing.

Internet sites such as Student Doctor Network are abuzz with this kind of information, and it is scoured daily by many applicants. It also requires checking e-mail many, many times a day, because interview slots fill quickly, and one must respond immediately to interview invitations in order to make the schedule work. I would have given anything for a Blackberry or iPhone so that I wasn’t literally tethered to my computer during those months.

Is this good for the applicant? Not really. Are there really that many programs that would be a true match—given geographical preferences of family and self, given a positive “gestalt” for some programs and not others, given preferences for 3- versus 4-year programs, and given that some programs are stronger than others in our particular areas of interest? Probably not. And the financial burden is great, given the fiscal constraints that plague students: air flights, rental cars, hotels, and food for each interview add up to an enormous amount of money. But it is better to match somewhere than not at all, so we all engage in the game with full vigor.

And yet with all of these difficulties lies a truth: You don’t know what’s out there until you see what’s out there. I have been quite happily surprised by programs that I did not initially consider to be “true contenders,” and the opposite has been true as well. Programs are not all alike, and one cannot know this unless one goes and visits.

While it has been burdensome to travel to so many places, it has also been a truly interesting and educational experience. The hidden gems have been the people encountered on the trail. Emergency medicine is a small community, and I am sure to run into all of these people many times over the coming decades. That part has been a pure joy—and fun.

Is this madness good for programs? Not really. Most of the program officials where I interviewed said they received between 550 and 700 applications this year. With well over 20 applications per applicant, on average, there is an enormous amount of extra administrative work associated with the match. It causes some programs to go to objective screening techniques, such as board score cutoffs, which prevent looking at the entire application and missing some great candidates. It also means there will be a lot of interview cancellations, particularly toward the end of the match season.

It means that the programs cannot really know that everyone applying is really interested in their particular program, or if they are just part of the numbers game. On the other hand, this is a program’s chance to reach out to and impress applicants who might otherwise not have known of their program.

With interviews done, there is an initial feeling of relief. The “requisite” number of interviews has been completed, and there are enough programs ranked to feel almost certain of a match. The hemorrhaging of money stops.

But after this feeling of relief comes a great deal of second guessing in terms of where one thinks one will match relative to where one’s preferences lie. They say the match favors the applicants, and we should rank programs solely on preference. But it is still a bit nerve-wracking, in part because, when one matches to a program, one is legally bound under contract law to go there—and what if it is choice number 5? The order matters, but one cannot know to what extent until Match Day.

It all comes down to Match Week, which this year is March 16-19. If an applicant has a successful match, he or she will get an e-mail on Monday of Match Week, saying the applicant has matched—but it does not say where. If unsuccessful, one will receive the dreaded call from the dean’s office. For those unlucky souls, Tuesday and Wednesday are scramble days, when applications are faxed, calls are made, and contracts are signed. Unfortunately, there are more unmatched applicants than available slots, so this is not a time to be picky, and it must be enormously stressful. All who matched find out where they are going for the next several years, en masse, on Thursday morning.

So, if you see applicants behaving oddly, your differential should include the following: matchitis, OCD, anxiety, and manic-like outbursts of energy. While you may be entertained and even empathetic, keep in mind that no psychological counseling, beta blockers, or anxiolytics will alleviate the symptoms. Like pre-eclampsia, the only definitive treatment is delivery—in this case of the envelope—as we enthusiastically await joining your ranks. n

Ms. Stankus is a medical student at the University of Washington and is a former medical malpractice defense attorney. She is an adjunct professor at Regis University and is a member of ACEP’s National Medical Legal Committee.