BY ROSANNE SPECTOR

For medical school seniors, finding out which medical residency program they'll be joining is a lot like getting a job offer -- only it's a job offer they can't refuse.

That accounts at least in part for the atmosphere of high anxiety at the Match Day ceremony held in the medical student lounge March 22. At Stanford, as at schools throughout the United States and Canada, medical school seniors learned on Match Day where they'll be serving as residents. Medical graduates must complete a residency -- which takes three to seven years, depending on the specialty -- before going on to provide direct patient care.

The National Resident Matching Program, the organization that pairs students and residency programs, allows schools to announce where students have "matched" an hour before the organization posts the information on its Web site. Students must accept the appointment for at least one year -- though in cases of extreme hardship, a contract can be broken.

So at 9 a.m. on March 22, nearly every Stanford medical student senior stood in the medical school's lounge, straining to hear associate dean of education Elliott Wolfe, MD, call the 88 names of students seeking residencies. One by one the students weaved through the crowd to reach Wolfe, who handed them an envelope holding the name of the program they would attend.

Though a few students might be disappointed with their matches, Wolfe cautioned before handing out the envelopes, most would be pleased. This year 81 percent of the students got their first choice and 92 percent got one of their top three choices.

Match Day culminates a nearly yearlong application and assessment process. Starting in the summer, students apply to individual residency programs. After visits and interviews, students rank the residencies in order of preference. Meanwhile, the programs rank the applicants. Finally all parties submit their lists to the matching organization and wait to hear the results.

Stanford students do very well in Match Day for a variety of reasons, explained Wolfe.

"First of all, our students are outstanding achievers. And as they make up their lists, they keep in mind where they truly want to go. And finally, we advise them to be realistic in their choices. That way they won't use the top positions on their lists for programs that are unlikely to choose them."

Medical student Neethi Panicker was elated over her match: She will be in the pediatrics program at the University of Chicago, where her fiancé is doing his residency. And though she found the match process stressful, she appreciated the coaching from Stanford's staff in how to create the residency "wish list." Wolfe's advice about the pros and cons of various residency programs, gathered from Stanford graduates who served in them, was particularly valuable, she said.

"I think they do a really good job of paying attention to the individual throughout the process," Panicker said. "There are so many students, but they pay attention to what's missing in our files, scan all of our letters into the computer and make sure everyone meets the deadlines.

"It's kind of nice to be at a small medical school where you get that much attention," she added.

At the same time the Stanford students learned where they'd be going, 23,973 other medical school seniors throughout the world discovered their matches as well. A look at the programs chosen by these students reveals that Stanford students have grown less interested in the primary care specialties (family medicine, internal medicine and pediatrics) than the average. Nationwide, 49 percent of the seniors matched to a first-year residency in primary care, just 1.5 percent less than last year. At Stanford, though, only 30 percent matched to primary care residencies -- a 20 percent drop from last year.

As for the 140 students from around the world who were matched to residencies at Stanford, about 20 are Stanford medical school graduates. Ann Dohn, Stanford's director of graduate medical education, said that as usual she was pleased with the incoming residents. "We ended up matching with our top choices in most of our programs," she said.