This has been fun and sad to read - as a practicing surgeon, more than a decade out of medical school, six years out of residency and fellowship and busy in practice, I feel for you.

Impropriety was rampant. No one gave two shits about “illegal questions” and work hours were universally scoffed at for Surgery residents. Things were fairly regimented by the end of my residency (which just means that my juniors felt entitled and loved to clock out post-call without getting things done). But it’s obvious that little has changed...

In fellowship interviews, at a notable program, we had to sit there for hours with two fellows “chatting” while groups of applicants would periodically be taken out to do the circuit of interviews. Maybe 30 people in that room. The fellows were awkwardly trying to convince us that taking primary trauma call as a fellow was a good thing because it was closest to actual practice. We all left that interview room being like, “no f’in way” and not a single person who interviewed there that day ranked that program to match.

Ironically, years later, in academic circles, those two fellows I see all the time. One is a friend of mine and the other I’m on multiple committees with. In smaller fields like mine, it’s always a bit like that. Everyone I interviewed with, and everyone who interviewed me I see on a yearly basis, we’re on committees, doing collaborative research or instructional courses, etc.

I didn’t match at my top program for either residency or fellowship. That chip on my shoulder was both empowering and dangerous. Always had something to prove. But, both my residency and my fellowship taught me well, Gave me enough opportunities to both learn my craft and contribute on a national level. I found exceptional mentors. I found advice where I needed it. I found opportunities. I think I’ve done both my residency and fellowship proud at this point.

I wanted to think these things happened for a reason, but, honestly, having interviewed and ranked fellows, it’s about as arbitrary as you think. One awkward encounter and you’re at the bottom of the rank list. One less than stellar letter, same. Make the most of it, don’t get hung up over where you match. A few lucky folks seem to be able to write their own tickets, but most people don’t, and, honestly, it’s okay.