Unlike 99% of MD and MD-PhD students at Harvard Medical School (HMS) who apply to residency, I did not match. I was initially shocked, assuming there must be some mistake. I waited for the next email to come saying the previous email had been sent in error. Surely, I must have matched somewhere. I had interviewed at all the top programs in Dermatology (Harvard, UCSF, Penn, Stanford, and Yale). I was told by advisors that my CV was not just gold plated, but "solid gold." Throughout the process people repeatedly assured me I would have my choice of residency programs, but then on Monday morning of Match Week, the email came that I didn't match.
At 35, my journey to academic medicine was longer than most. I spent 6 formative years between undergrad in Oklahoma and HMS marked by many adventures: I started a non-profit, filmed a documentary, lived at the source of the Nile, got 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 investigating the genetics of autoimmune disease at the Oklahoma Medical Research Foundation and later at the University of Michigan. At HMS and MIT, I was fortunate to work alongside great friends and mentors to develop technologies for single-cell sequencing that took me around the world and back, studying neglected diseases.
I discovered Dermatology while working on leprosy, and I was excited to explore the skin as a vehicle to understand human disease -- to see skin lesions through the eyes of a microscopist and look at pathology through the eyes of a clinician. Beyond this, I spoke openly about re-envisioning the academic paradigm while on the interview trail -- joint labs, non-eponymous science, scientific communication not bound by academic publishing, and launching companies alongside an academic research lab. I spoke about how I see the limitations of the 80-20 physician-scientist model: that it has never been harder to secure NIH funding, but never easier to start a company. I spoke about the experiences I have had and my vision for the future with passion and excitement.
I played a hand and came up empty. Perhaps, I should have played it safe -- told people what they wanted to hear. But I am proud to say that I was nothing other than myself. While I was initially shocked at not matching, my disbelief was quickly replaced by relief and immense gratitude at being able to pursue my dreams on my own terms. In so many ways, the universe made a hard decision on my behalf. I feel liberated from the anxiety and expectations that all too often dominate life in academic medicine, particularly at HMS. I was given permission to step off the conveyor belt. As I told my program director, I feel that I have been given the greatest gift of my life.
Try as I might, I have struggled to find a downside to the outcome. The value proposition of residency training along the path to scientific independence is truly daunting. The PGY-scale allows residents to merely survive, but not thrive in a phase of life where family planning often becomes a reality. Without the ability to negotiate on salary, benefits, or childcare, trainees desperate to simply match are forced to accept far less than they are worth in pursuit of a calling that annually seems less and less viable. The thought of not being overworked and underpaid for the next decade, not fighting for grants or tenure, and not having to underpay talented trainees in the academic establishment is incredibly liberating. I feel free to chase ideas that I previously didn't have the courage or bandwidth to pursue, and I might actually finish my book.
At present, I am fortunate to have 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 multi-modal molecular analysis to unlock clinical data to improve diagnosis and management of numerous diseases. At nference, I have the opportunity to work with thought leaders in academia and industry to leverage technology to think about big problems in fresh ways. I am excited to color outside the lines to bring new perspective and imagination to the future of medicine.
Most of all, I am excited 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 drive 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 experience of near loss reiterated the importance of moments with family and left me with immeasurable gratitude to the care teams who saved the lives of my wife and daughter. So, to all who matched last month or in years past: thank you for all the lives you touch. I am proud to count many of you as friends and colleagues, and while we might not be co-residents, I am with you in spirit as you care for patients.
While there is certainly a sense of loss and tragedy in not seeing patients directly, I won't miss being called "Dr. Hughes." I had grown fond of introducing myself as Travis as a medical student, and I was wary of the power dynamic and distance of professional title, even when residency appeared certain. Although I am now unsure of my ultimate place in science and medicine, I find myself re-invigorated at the prospect of new adventure, and I remain no less committed to advancing human health through science and innovation. I see this moment as a true gift -- the opportunity to heal the world in new ways as just Travis -- which is enough.
is an MD-PhD student at Harvard Medical School and MIT, and a clinical scientist at nference.