The 2020 graduating class of medical students has been anticipating this season for years.

Tony Gjocaj, at the Michigan State College of Human Medicine, has been dreaming of Match Day ever since he was in middle school. Taylor Novice, who will be graduating from the University of Michigan Medical School and the Ross School of Business with her MD/MBA, cannot remember a time when she did not want to be a doctor.

Instead, a spring that traditionally brings recognition and celebration has become a time of stark uncertainty. On top of that, Gjocaj and Novice both have had to rescheduletheir respective May weddings.

Fourth-year medical students in Michigan were pulled from patient contact across the state in mid-March because of the coronavirus pandemic, marking an abrupt end to their final clinical rotations. Match Day banquets, scheduled for March 20 to honor the release of the National Resident Matching Program results, when students learn what hospital they will be placed in for their medical residency, were canceled and replaced with a day spent on FaceTime with loved ones. Graduation ceremonies planned for the coming months have shifted to be held virtually, if at all.

For students that matched with residency programs in-state, they have watched Michigan rise to be among the top 10in the nation for known coronavirus cases a pandemic hotspot, particularly in southeast Michigan.Incoming residents are grappling with an eagerness to join the front lines of COVID-19 care while experiencing some relief that they have a moment to prepare themselves before doing so. The excitement of altruism and commitment to service, lingering with an awareness of the risk and inevitable fear.

We sit in this limbo, explains fourth-year Wayne State School of Medicine student Andrew El-Alam, were overqualified students, but underqualified physicians.

Andrew El-Alam, medical student of Wayne State University poses for a photo in Detroit, Tuesday, April 21, 2020.(Photo: Junfu Han, Detroit Free Press)

In recent weeks, the Michigan Department of Licensing and Regulatory Affairs issued a directive allowing medical students who have successfully completed their academic requirements to secure an education license early. With the licensing option, graduates can enter the workforce ahead of the typical July 1 start date, helping to bring some relief to an already overworked army of health care workers fighting a medical war against an invisible and unforgiving enemy.

After consulting the students and the residency programs at which they were placed, Michigan State is one of the universities expediting the licensure of health care professionals entering the workforce from the colleges of Human and Osteopathic Medicine. For residencies in the state of Michigan, 61 students in MSU's College of Human Medicines graduating class are eligible.

If a residency or hospital wants to start their people early we are making that possible, said Dr. Aron Sousa, interim dean of the College of Human Medicine at Michigan State.According to Sousa, the students will be available as soon as May. He noted that early licensure is a choice that students can opt-in to. There are a lot of things that have to happen for this to work for people, he acknowledged, but that were just trying to make our people available to do good in the world.

Leadership at Oakland University's William Beaumont School of Medicine also havepresented early licensure as one option among several others, including research, telemedicineand volunteering opportunities, for fourth-year students. At present, the University of Michigan Medical School does not have plans to graduate doctors earlier than expected. Similarly, Wayne State School of Medicine will conduct graduation as scheduled for June 2.

Having residents start earlier than July 1 could relieve hospitals whose providers have become sick or exhausted, but poses additional logistical challenges and an increase of work to onboard new staff. A University of Michigan spokesperson confirmed that residency programs at Michigan Medicine will not start earlier than scheduled, stating, starting the new doctors in their usual time sequence and orientation this summer will allow the faculty physicians now focused on the urgent pandemic patient care needs to maintain that focus.

Graduates across the state are staying prepared for either scenario.

No one truly ever feels prepared for residency, said Craig Matisoff, a Michigan State College of Human Medicine student who matched at Spectrum Health in Grand Rapids. It is a really difficult transition in the best of times, and I think this (pandemic)has just compounded a lot of those feelings. At the same time, it is hard to just sit on the sidelines knowing that we are capable, we have been prepared and are ready to contribute.

Matisoff said he would welcome the opportunity to begin earlier if needed:Im happy to support the folks here in west Michigan, but I would be lying if I said I wasnt nervous about the whole prospect as well.

Safetyand the possibility of becoming a vector for the virus, is a primary concern. Tony Gjocaj, who matched in family medicine at Beaumont HospitalWayne, has been following its response to COVID-19 on the hospital's Instagram to get a sense of if it may need additional support in the coming months. While that location initially intended to convert to a center specifically for COVID-19 patients, staff has now been deployed to other hospitals in the Beaumont system and Wayne is serving as a reserve hospital in case of a surge.

Gjocaj has already submitted the required paperwork for early licensure, but hesitates to say for certain whether he would elect to start his residency early.

I think I would. I would if I knew the proper PPE (personal protective equipment) was in place and it was safe to do so. That is the No. 1 thing. We do not want to hurt people by contracting the virus ourselves and spreading it to others, he explained. Quoting the oath he has yet to take at graduation, do no harm, he said.

Some representatives from programs on the west and east side of the state say they do not anticipate a need to start first-year residents before the usual July 1 date. Major hospitals in metro Detroit, including Henry Ford Hospital, are in aStage 2: Increased Clinical Demands status in line with the updated guidance by the Accreditation Council for Graduate Medical Education (ACGME) in response to the pandemic. That status allows residents to focus solely on caring for the crucial surge of COVID-19 patients while educational activities are suspended.

Dr. Kimberly Baker-Genaw, vice chair of Internal Medicine and director of Medical Education at Henry Ford Hospital, said she is optimistic that countermeasures will continue to flatten the curve, and it will not be necessary to disrupt asmuch day-to-day education and patient care activities to direct all staff to COVID-19 care, even given a possible surge in the fall.

Im hoping in the fall that we do not see this surge, she added, but if people dont socially distance and we see the resurgence of the spread like we had initially I think it is possible again.

It remains unlikely that residents will be dispatched to field hospitals, such as the ones recently erected at the TCF Center (formerly Cobo Center) in Detroit or at the Suburban Showplace Collection in Novi, unless the state sees another extraordinary surge in cases.

There are so many variables at play that LaVana Greene-Higgs, who is part of both the University of Michigan Medical Schools graduating class and the incoming residency cohort, is unsure of how to brace herself for what comes next. She articulates the question hanging over the class of 2020:Im trying to figure out what it looks like to begin training in a pandemic. Until then, she is staying up to date on the guidelines and recommendations for COVID-19 treatment.

LaVana Greene-Higgs, graduating U-M medical student and incoming resident at Michigan Medicine poses for a photo in Ann Arbor, Wednesday, April 22, 2020.(Photo: Junfu Han, Detroit Free Press)

Wayne State student Andrew El-Alam, who matched in emergency medicine at Henry Ford Hospital, hopes that by his July start the incoming coronavirus cases are at a more manageable level.

Ive come to terms that this is likely going to be here for a long, long time. But hopefully not at this level, he said. El-Alam said he felt suited for emergency medicine after growing up working in his parents restaurant, and pursued the specialty out of a desire to help people at their most vulnerable.

Dr. Candace Smith-King, vice president for academic affairs at Spectrum Health, aims to have adjusted to a new normal before residents begin in July. COVID-19 is not going to just disappear, were going to have to learn how to function with it within our health care system, she explained.And how we do that as a health care system has yet to be determined.

The incoming class of residents are asking that central question, too, and will play a role in answering it. They can expect to care for COVID-19 patients until a treatment is determined or a vaccine is available, but could also see sicker than normal patients who may have been impacted by the consequences of prolonging care. Residency programs may transition some of the orientation process to be held virtually, but plan to begin patient care uninterrupted in July.

Theyre coming into a situation where there is more uncertainty, Smith-King acknowledged.They may learn medicine differently. The hospital may look different. Those details are yet to be understood all the way. But theyll still be the ones going in to take care of patients. Theres no way, really, for our hospital to function without them. They are an integral part of what we do.

Matching into the obstetrics-gynecology residency at Beaumont HealthRoyal Oak was fulfilling a lifelong dream for Alison Thomas, particularly since 23 of her cousins were born there. Thomas, who will be graduating from Oakland University's William Beaumont School of Medicine, has expressed to the university her interest in their option to graduate early and plans to remain flexible.

Alison Thomas of Orchard Lake is seen outside of her home on Tuesday, April 21, 2020. Thomas is at the Oakland University William Beaumont School of Medicine and has expressed to the university her interest in their option to graduate early and plans to remain flexible. Alison matched into the obstetrics-gynecology residency at Beaumont Health, Royal Oak where twenty-three of her cousins were born.(Photo: Ryan Garza, Detroit Free Press)

Thomas has braced herself, knowingthat the pandemic will shape the start of her medical career. It is definitely an added stressor," she said.But this is history.

She acknowledged that it is an amazing opportunity to learn how to handle and work through a pandemic. In the end, its just going to help me learn more and help me be more equipped if this ever happens again. And, as she says, Moms will still be delivering their babies regardless of whether were in a pandemic or not.

For all, this moment in time represents precisely why they chose to become doctors. In just a few weeks, the graduating classes will take the Hippocratic Oath for some, only quietly to themselves reciting, And may I long experience the joy of healing those who seek my help.

The vice dean of Medical Education at Wayne State University School of Medicine, Dr. Richard Baker, has confidence in the class of 2020. As he says, Wayne State is graduating 290 leaders.

This is a heroic time. They will be heroes, whether they want to or not. Its scary, Baker said, adding, This experience for this cohort of students going to residency will probably change them forever. But theyre up to the task.

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