“How long could Long Island be?” I remember asking myself just before I realized that it would take a 2-hour train ride to make it to my orthopaedic residency interview on time. The cab fare for missing that train (which ran a different schedule on the weekend) was extra punishment for saving a few dollars by staying with a friend.

This was just one of the lessons I learned while on the interview trail. I also discovered that the snow-covered streets of Chicago are no place for loafers, that staying in a cheap, dog-friendly motel on the wrong side of town is not the best way to sell a city to your pregnant wife, and that balancing the mental, financial, and emotional demands of the interview process are good training for what will follow in life.

Matching an orthopaedic surgery residency position has a high price tag, one that caused me to empty my wallet, swallow my pride, and deliver a dozen roses on more than one occasion. However, the experience was unforgettable.

The appeal
Over the past few decades, technology, innovation, and respected physicians have driven the field of orthopaedic surgery to the forefront of medicine. As a result, it’s become one of the most sought-after specialties for medical school graduates.

A quick economics lesson demonstrates that the demand for positions far exceeds the available supply when it comes to orthopaedics. In 2011, 1,013 applicants—including 820 graduates from U.S. medical schools—applied for 670 orthopaedic residency spots distributed among 158 programs. Many applicants, who are typically carrying medical school loans in the five or six figures, spend about $1,000 on the application fee and apply to 40 or more programs.

Each year, the National Resident Matching Program (NMRP) releases data on those applicants who match, as well as on those who did not. These data include board scores, Alpha Omega Alpha honor society status, research projects, and the number of programs ranked, and they compare the populations of applicants who did and did not obtain positions.

Many of these categories have shown an increase in the past few years. For instance, the average Step 1 score for the class of 2007 medical graduates was 234; in 2011, it was 240. The average Step 2 score has also increased 10 points over the past 4 years. This data set is one example of how the orthopaedic match has become increasingly competitive.

The wait
After sending off my application, I waited—for an eternity, it seemed—to receive my interview letters. Applicants for other residency specialties, such as internal medicine and pediatrics, had already completed their interview season before I received my invitations. It was an exercise in patience and humility. Truly, I was glad to have friends who were also applying for orthopaedic residencies to reassure me that the invitations simply had not been mailed yet.

The test
Invitations finally came, and I started my traipse along the interview trail. Memories that still make me laugh include the mental stress of playing Operation with my non-dominant hand, trying to assemble a puzzle before the egg timer rang, and naming movie quotes.

The financial strains of traveling to the various residency locations with limited means (typically loan money) put me in some awkward situations. The classic sign of a thrifty interviewee—and one that got me a few comments—is that the interview outfit and the application photo are identical. To save money, I tried to stay with people I knew and to host fellow interviewees when they visited my home programs, but at times the relationships were a bit awkward.

I offered to house an interviewee from Boston, who actually took me up on the invite (to my wife’s surprise). Although she won’t come out and say it, I think my wife enjoyed spending the day touring Memphis with his fiancé, even though she was a complete stranger. Overall, this experience brought a wealth of good stories and even better friendships.

The Match
Finally, the third Thursday in March—Match Day—arrived. You could see the raw emotion and drama on our faces and those of our family members. It was like the NCAA basketball teams on “Selection Sunday” for the National Championship Tournament.

At noon, the list went up and we felt “the thrill of victory or the agony of defeat.” Celebrating with my classmates was unforgettably joyous. The fact that I had matched and come one step closer to achieving my goal was worth every penny and gray hair.

George V. Russell Jr, MD, an orthopaedic traumatologist at the University of Mississippi Medical Center, asks every rotating medical student, “How bad do you want it?” I think this phrase sums up the demands and sacrifices of the orthopaedic match process, much like residency and a future career. Though it is intense, the process is wildly rewarding. The opportunity to meet colleagues and mentors across the country is worth the cost, and I am grateful to all of those who came before me to make this possible.

Geoffrey I. Watson, MD, matched at the University of Mississippi Medical Center and is currently in the orthopaedic residency program there. He can be reached at gwatson@umc.edu