Nikki Alworth stared at the envelope, then stared again, her eyes scanning the words over and over. She wasn't imagining things. The University of Maryland medical student would remain at the university to begin her career as a doctor in emergency medicine. No need to sell the house in Rodgers Forge. No need for her husband to find a new job and to hunt for new day care for their 18-month-old daughter, Finley. And no need to fret any longer - she got her first choice.

With the uncertainty of health care changes and a shortage of primary-care physicians hanging over their profession, Alworth and the more than 16,000 seniors at 130 medical schools across the nation had a lot to consider Thursday as they simultaneously ripped open “Match Day” letters, notifying them of where they'll spend their postgraduate training.

While some students pondered the future of their profession, for many, the letters foretold the paths their personal lives will take over the next few years - whether they would move or stay in place, join a significant other or be separated, pursue a dream or settle for something less.

Tears came to her (Alworth) eyes as she opened her letter, relieved at the prospect of staying home, but also invigorated at the opportunity to practice at a top-notch program. It was quite a personal accomplishment, she said, after juggling a toddler and medical school's punishing schedule. “It's been extremely challenging, and we've made huge sacrifices in our personal lives over the years,” Alworth said.

At the University of Maryland's 198-year-old Davidge Hall, the annual ritual was steeped in tradition, suspense and plenty of drama. Crammed into the round auditorium, students and their families cheered as the names of 161 students were called one by one. Before accepting their envelopes, each student placed $5 into a gold shopping bag, with the last to be called receiving the jackpot.

Some walked quietly back to their families and opened their letters with a shriek, a shy smile or tears. Others remained at the podium and pronounced their match aloud, to the whoops of approval from classmates. Similarly, across town at Hopkins, the excitement filled the common area of the Armstrong Medical Education Building as students shared a hearty champagne toast, then counted down to the unveiling of folded, sealed papers. Upon opening the documents, many students let out loud screams of joy, and there were hugs all around. Some posed with fellow students, holding up their papers to cameras.

The school's new urban health residency program aims to create leaders in primary care fields trained to tackle problems such as diabetes, alcoholism and domestic violence. Hopkins student Paul Doherty, 33, of Waynesboro, VA was among the four residents named to the program, having spent eight years before medical school helping to get treatment for HIV/AIDS patients, drug addicts and the homeless.

He said his drive to enter the urban health residency came in part after he met a woman in the D.C. area affected with AIDS. He helped her acquire Medicaid and Social Security for receiving proper treatment, and then she went from skeletal, feeble and unemployed to healthy and capable enough to rejoin the working world.

Dr. Richard Colgan, director of medical student education in family medicine at the University of Maryland, said he was encouraged by the increase of students going into primary-care specialties - 37 percent at Maryland, up from 32 percent last year. If health reform passes, more primary-care doctors will be needed for the newly insured, he said.

Still, Colgan didn't expect that students were too concerned about the political wranglings over a health bill. They just want to be good doctors, he said. With that goal in mind, students were preparing to serve at home as well as abroad. Hopkins student Brian Englum, 29, will serve his general surgery residency at Duke and said he hopes to take part in the school's new foreign initiative.

As a Peace Corps volunteer, Englum performed services in Benin, West Africa, in villages in need of better sanitation, HIV/AIDS education and health care for mothers and babies. He performed similar duties in the Congo.

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