Match Day — One CHM Student's Journey to Residency

For future doctors,
landing a top residency is no Club Med

By Pat Shellenbarger
Copyright 2005 The Grand Rapids Press
All rights reserved. Used with permission.

Vinko Zlomislic had been awaiting this day for four years -- actually, most of his life.

He and 27 other medical students fidgeted and chatted in a downtown banquet room, killing time, anticipating, some perhaps dreading the news they were about to hear. They knew they had passed their classes, knew they would graduate from Michigan State University's medical school in May, knew they had fulfilled nearly every requirement for becoming doctors.

The one thing they didn't know was where they would spend the next three to five years.

For Zlomislic, a former professional soccer player, the anticipation had a familiar feel.
"It's a little pregame kind of nervousness," he said.

Dr. Kent Bottles, head of the Grand Rapids Medical Education and Research Center, arrived, clutching 28 envelopes that, in minutes, would end their suspense.

After at least four years of undergraduate study and four years of medical school, match day had arrived. All over the country, 16,000 fourth-year medical students waited in restaurants, conference rooms, classrooms and elsewhere, counting down the seconds to noon Eastern Standard Time on March 17, the precise moment they would learn what hospital residency programs would take them for the last step in their education.

Two weeks before match day, Zlomislic sat in the Grand Rapids apartment he shares with two MSU medical students.

"We talk about this all the time, wondering where we're gonna end up," he said. "Some days, I'm really confident I'm gonna get my number one pick. Other days I'll go to bed and I'll think, what if I don't match? There is no backup program. If I don't match, I don't know what I'm gonna do."

He wore an MSU baseball cap turned backward and a shirt from the Los Angeles Galaxy, one of the major league soccer teams for which he played. Back then, he knew he could be traded, sent down to the minors or cut at any moment.
"It was out of my hands then," he said. "It's out of my hands now."

Staying focused

In a break room at Spectrum Health's Blodgett Campus, Dr. Jeffrey Wilt is briefing three medical students, including Zlomislic, at the start of a one-month rotation in the intensive care unit, their last assignment before beginning their residency programs -- where, they still don't know.

"Welcome to the last bastion before graduation," Wilt says. "You have a lot of nurses here who are your allies. Please don't make them your enemies. You will regret it."

"You are part of a team. If there are procedures to be done, we want you to do them. The goal of this is to tune you up to be interns," the title they will carry their first year of residency.

"You have to take two exams," Wilt says. "One is on shock next Wednesday, the day before match day. I'm sure all you guys will be focusing on shock."

He's joking. He knows they'll be focusing on match day. Not all attending physicians are as understanding. Some delight in pimping the students. Ask a question a student can't answer just to remind them how little they know. Put them on the spot, embarrass them in front of their peers.

It's all part of becoming a doctor.

Two passions, one lifetime

For Zlomislic, 28, it's always been about medicine and soccer. Almost as soon as he could walk, he began playing soccer. His father is from Croatia, his mother from Hungary, where soccer is king. He was born in California but didn't learn English until he started kindergarten.

When he was 8, his great aunt died from a stroke. He saw her decline, become a person he didn't recognize and die. That's when he decided he wanted to be a doctor.

But his other passion commanded most of his time. He played in youth leagues and on his high school team, then went to UCLA on a soccer scholarship.

Sometimes, he'd get injured and need a doctor's care, and he'd wonder, "Why doesn't he listen to me? It seems like he's blowing me off," he recalled. "I wanted to be better than they were. I'm going to be a doctor who listens to my patients."

But medicine would have to wait. After college, he signed with the San Jose Clash, was sent down to a minor league team, then called up to the big leagues the second half of the 1998 season. The next year, he was traded to the Los Angeles Galaxy and spent 1999 shuttling between its minor league club in San Diego and the major league team in LA.

He played a season for a team in Germany, then made the U.S. Olympic Team as an alternate for the 2000 games in Sydney. Back in the states, he rejoined the Galaxy. During an exhibition game against a team from Mexico, he leaped to deflect the ball with his head. His goalie tried to knock the ball away but, instead, punched Zlomislic in the head. He crumpled to the ground, out cold in a tangle of players.

The blow to the head was the least of his injuries. His left knee was a mess and the tibia, a major bone in the leg, was fractured.

"Now would be a good time to hang up the cleats and pursue this other goal I have for myself," Zlomislic said. "It was definitely a turning point."

He decided to specialize in orthopedic surgery, putting broken bones back together, replacing worn-out hips and other joints. While recuperating, Zlomislic applied to several medical schools, and the Galaxy sent him down to its minor league team in El Paso.

That settled it.

"I didn't want to be caught doing this for years, playing minor league soccer," he said.

He wanted to make a difference in people's lives. His childhood in a suburb of Pasadena hadn't shielded him from the suffering in Croatia, the land of his father. Two of his uncles were killed in the civil war that broke out during the early 1990s.

As a young man, Zlomislic volunteered in the refugee camps in Croatia. He saw the pain, the families torn apart, and he knew he had been spared only because his parents had immigrated to the United States decades before.

"That just reaffirmed my interest in medicine," he said.

Four years ago, he began his studies at MSU. The first two years, he spent in classrooms in East Lansing. The last two, he got hands-on experience in hospitals through the Grand Rapids Medical Education and Research Center, a joint program of MSU, Grand Valley, Spectrum Health and Saint Mary's Health Care.

Third- and fourth-year students rotate through several departments and hospitals to get a varied experience. Studying medicine in books is one thing. Dealing with sick and injured patients is "scary, humiliating, humbling," Zlomislic said. "I can't describe it. You feel like you -- I don't want to say are worthless. I just don't want to get in anyone's way or mess anything up."

His second day at Saint Mary's, a woman grabbed him by the arm.

"My dad's having chest pains," she said.

"I was like, oh, my gosh," Zlomislic said. "He's grabbing his chest. All of a sudden I'm on the spot. I knew how to handle it knowledge-wise, but I didn't know where anything was. I thought, this guy's having an M.I. (myocardial infarction, or heart attack)."

He pushed the intercom button for the nurses' station and paged the resident on duty. The patient lived, but "I was totally freaked out," Zlomislic said. "It was definitely a reality check."

During a rotation at a Los Angeles hospital, a man was brought in with a broken ankle from an auto accident. A surgeon handed Zlomislic the scalpel. He'd never before cut living human flesh. He looked at the ankle, thought about what he needed to avoid -- arteries, tendons -- then cautiously sliced the skin.

The surgeon looked at him. "He's like, 'Don't be a wimp. Come on, man. Let's not waste time. Let's get down to business,' " Zlomislic recalled. He cut deeper, opened the incision, drilled into the bone and reassembled the broken ankle with screws and a metal plate.

That was last fall. By then, Zlomislic's mind was on the future. In a few months, he would graduate and officially become an MD, but he couldn't practice medicine on his own until completing a five-year residency.

The length of residency varies from three to five years, depending on specialty. The process began last July when Zlomislic and thousands of other third-year medical students filled out applications online. The Electronic Residency Application Service sent the applications and letters of recommendation to university and hospital residency programs designated by the students.

Zlomislic had his application sent to 45 programs. He was invited to interview at 15. He chose 10. Thus began an exhausting dash, criss-crossing the country for interviews over a few weeks in December and January -- San Francisco one day, Boston the next, LA Thursday, Chicago Friday.

The interviews were as varied as the institutions. At the University of Southern California, he walked into the interview room and saw the children's game Operation on a table. Remove as many pieces as you can in two minutes without setting off the alarm, he was told. In the next room, was another Operation game. This time, a doctor fired questions at him as he removed the pieces.

He had two more interviews left, one in Los Angeles, the last in Seattle. Enroute to LA, he missed his connecting flight in Chicago and caught an hour's nap on a cot. He stumbled into UCLA a couple hours late and exhausted and was shuttled through a series of interviews. In the last room, two doctors pointed to a karaoke machine. You like karaoke?" they asked.

He'd never actually sung karaoke.

"Well, you're gonna sing karaoke for us," they said.

They chose the Aretha Franklin number "Respect."

"I figured, what the heck," Zlomislic said. "I'm gonna pretend I've had a couple of beers. I belted it out."

He thought of canceling his last interview in Seattle but decided to keep it. He's glad he did.

In February, the medical students submitted their preferred hospitals in order to the National Resident Matching Program. Likewise, the hospitals submitted their lists.
Zlomislic placed the orthopedic surgery program at the University of Washington Affiliated Hospitals in Seattle at the top of his list.

All the lists went into a computer, which compared them, matched them and in mid-March spit out its decision.

Its judgment is beyond question and must remain confidential until the third Thursday in March each year to avoid undue influence.

Once the match is announced, each student is contractually obligated to go where the computer sends them. More than a few years could hinge on it, since 70 to 80 percent of doctors set up practice where they serve their residency.

"I look back at my application, and I'm pretty confident," Zlomislic said, "and then other days I realize how random this process is.

"Right now, what's determining where I go is a computer algorithm that has no human control."

A medical draft

Twenty-eight medical students, their spouses, parents and babies gathered in Bistro Bella Vita downtown for the medical equivalent of the NFL draft.

Jessica Stacey, a Rogers High School graduate, sat next to her husband, Rob, wondering where they would spend her three years' residency in emergency medicine. She had gambled, listing only three programs: Spectrum Health, Indianapolis and Kalamazoo, in that order.

Jill Jennings hadn't slept the night before.

"It was just not knowing where," she said. "It was the suspense of it."

Zlomislic sat with his girlfriend, Alex Hurlburt, a third-year medical student in Chicago.

A few minutes before noon, Bottles, assistant dean of the MSU College of Human Medicine and CEO of the Grand Rapids center, said, "It's about that time."

He handed out the envelopes, led the students in a countdown, and they tore them open.

Stacey dialed her cell phone. "We're staying here," she told her mother. Jennings, too, got her first choice: Spectrum Health.

Zlomislic held his letter close to his chest, his face inscrutable. Then he smiled.
"Seattle," he said.

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July 22, 2008