“We’re sorry, you didn’t match any positions”

Unlike 99% of Harvard Medical School (HMS) MD and MD-PhD students who apply for residency, I did not match. I was shocked at first, assuming there must be some mistake. I waited for the next email saying the previous email was sent in error. Surely, I must have corresponded somewhere. I’ve interviewed at all the top dermatology programs (Harvard, UCSF, Penn, Stanford, and Yale). Advisors told me that my CV was not just gold plated, but “solid gold”. Throughout the process, people repeatedly assured me that I would have my choice of residency programs, but on the Monday morning of game week, an email arrived stating that I did not match.

At 35, my path to academic medicine has been longer than most. I spent 6 formative years between undergraduate in Oklahoma and HMS marked by many adventures: I created an association, shot a documentary, lived at the source of the Nile, obtained a master’s degree, spent time in Jamaica and worked as a caregiver for a man I met on Craigslist. My research journey began with an investigation into the genetics of autoimmune diseases at the Oklahoma Medical Research Foundation and later at the University of Michigan. At HMS and MIT, I was fortunate enough to work alongside great friends and mentors to develop single-cell sequencing technologies that took me around the world and back, studying neglected diseases.

I discovered dermatology while working on leprosy, and was excited to explore the skin as a vehicle for understanding human disease – to see skin lesions through the eyes of a microscopist and look at pathology through the eyes of a clinician. Beyond that, I spoke openly about rethinking the academic paradigm in the interview — joint labs, non-eponymous science, science communication unbound by academic publishing, and launching businesses alongside a lab of university research. I explained how I saw the limitations of the 80-20 physician-scientist model: that it has never been harder to get NIH funding, but never easier to start a business. I spoke about my experiences and my vision for the future with passion and enthusiasm.

I played a hand and came out empty. Maybe I should have played it safe — told people what they wanted to hear. But I’m proud to say that I was nothing but myself. While I was initially shocked at not matching, my disbelief was quickly replaced with relief and immense gratitude that I could pursue my dreams on my own terms. In many ways, the universe made a difficult decision on my behalf. I feel freed from the anxiety and expectations that too often dominate life in academic medicine, especially at HMS. I was given permission to step off the treadmill. As I told my program director, I feel like I have received the greatest gift of my life.

Despite my best efforts, I struggled to find a downside to the result. The value proposition of residency training on the path to scientific independence is truly daunting. The PGY scale allows residents to simply survive, but not thrive in a phase of life where family planning often becomes a reality. Without the ability to negotiate over pay, benefits, or childcare, interns desperate to just match are forced to accept far less than they are worth in pursuit of a vocation that seems less and less every year. less viable. The idea of ​​not being overworked and underpaid for the next decade, not fighting for scholarships or tenures, and not having to underpay talented interns in the academic establishment is incredibly liberating. I feel free to pursue ideas that I previously didn’t have the courage or the bandwidth to pursue, and I might even finish my book.

Right now, I’m blessed with opportunities to make a difference in the world in new ways. For the past 3 years I have worked at nference, a Cambridge-based health technology company, where I am able to leverage natural language processing and multimodal molecular analytics to unlock clinical data to improve the diagnosis and management of many diseases. At nference, I have the opportunity to work with thought leaders from academia and industry to leverage technology to think about big issues in new ways. I’m excited to color outside the lines to bring a fresh perspective and imagination to the future of medicine.

Above all, I am delighted to share extra moments with my wife and daughter. During my clinical rotations, my wife had a placental abruption at 29 weeks, and after a frantic journey to Massachusetts General Hospital, our daughter was born in an emergency C-section. While both are healthy and thriving today, nearly 2 years after our 2-month NICU journey, the near-loss experience reiterated the importance of family time and m left immeasurable gratitude to the care teams who saved the lives of my wife and daughter. . So, to everyone who has corresponded in the last month or in the past years: thank you for all the lives you touch. I am proud to count many of you as friends and colleagues, and although we may not be co-residents, I am with you in spirit as you tend to patients.

While there is certainly a sense of loss and tragedy in not seeing patients directly, I will be sure to be called “Dr Hughes”. I had taken a liking to posing as Travis as a medical student, and I was wary of the power dynamics and distance of the professional title, even when residency seemed certain. Although I am no longer sure of my ultimate place in science and medicine, I feel invigorated at the prospect of a new adventure, and I remain no less determined to advance human health through science. and innovation. I see this moment as a real gift – the opportunity to heal the world in new ways as Travis – which is enough.

Travis Hughes, PhD, MPH, is a medical and doctoral student at Harvard Medical School and MIT, and a clinician scientist at nference.