One of the things that they never mention when you are getting ready to go to medical school is what residency is about. Some people have ideas about what residency is, and some people are completely clueless. You can usually find these people on SDN with about 3 posts asking something like “How do I become a neonatologist”. That being said, the schools just sort of assume that you know what you are getting into. They have long sessions devoted to helping you get your ERAS (residency application) set up, your NRMP (matching service). They don’t mention what happens after you match (or if you don’t).

After you match or scramble, your residency position of choice sends you a packet of information that you have to fill out. If you have ever tried to join the military, the paperwork is basically the same. Some states are ridiculous about what they want, others noticeably less.

First, you have to apply for a limited license, so that you can practice as a resident. Each state has their own form for this, but they all have the basics. One state in particular has you list every single job you have ever had, along with all schooling, any periods where you weren’t in school or had a job, and probably your thoughts if you would like to put them on paper. They also make you go down to the local jail so you can be fingerprinted (twice!) at the same processing center as the other drug dealers. Sometimes you get to stop in the middle of yours so that they can take care of people with less patience than you. Sometimes you get spit on too.

You will also require at least 2 photographs of yourself, which, while not hard to get, are still a pain. Plus, you must pay for these things with either a cashier’s check or money order, because if anyone knows who it is that has bad credit, it is the future doctors of your state. Not that you didn’t already check them through NCIC with the whole fingerprinting thing. You also have to explain any and all criminal procedings, including but not limited to speeding tickets in excess of $100 (I’ve never had a ticket that cheap, who out there has?) Then you will need a state tax form (if you have state taxes), a federal tax form, a hospital code of conduct, a school of medicine (if so affiliated) code of conduct, a hospital confidentiality statement (HIPAA), employment eligibility verification form, a licensure policy, a Controlled Substances Act form, a USMLE/COMLEX policy (must take Step III by certain date), signing up for PALS, NALS, ACLS, ATLS, and last but not least, a hospital health screening form.

The screening form cracks me up, because it is the same form they use for the janitor apparently. One of the questions asks if you have or ever have had diabetes, then has in parentheses “sugar disease”. The really bad places don’t even give you envelopes for this stuff, and the extremely bad ones make you print out everything from an online site, but don’t tell you about it until an email shows up 2 weeks after the match. Not that I’m bitter or anything.

Last but not least of these is your “contract”. I put it in quotations so that you know that it really isn’t a mutual agreement as much as it is a mandate. You can either do what this piece of paper says, or you can not have a job and not apply for the match for the next 3 years. Seems about fair. Thankfully Congress prevented us from suing the NRMP over anti-trust issues by giving them a special exemption.

Not to dissuade anybody though, because it isn’t any different anywhere else you go. The biggest pain is that you will get to fill out all of this paperwork each and every time you start working at a new hospital. However, you can negotiate the terms of the contract after you are out of residency.

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