NEW ORLEANS — It all comes down to an envelope.

After names were called and they had their envelope in hand, some Tulane University medical students opened them right away.

Others held theirs tightly, waiting to open them at the same time as their classmates. Many students took their envelopes to where their families were gathered, or called their parents on the phone.

A few went outside, taking a moment alone before pulling out the single piece of paper that would determine whether they would start their new lives near California beaches, Colorado mountains or East Coast capitals — or for some, whether they would remain in New Orleans.

There were shrieks, cheers, hugs, high fives and tears — lots of tears. Tears of joy, tears of relief, tears of disappointment, tears for imminent separation from boyfriends and girlfriends and bittersweet tears at knowing that soon they would be leaving the world they know to begin the next step of their lives.

It was Match Day across the nation Friday for graduating medical students — the day they find out where they will begin their residency programs.

Ryan Roach and his girlfriend hugged tightly, surrounded by friends in a large and rowdy group hug. They both got their first choices and will be heading to New York City after they graduate.

It means the world, Roach said of the ceremony and celebration, held for Tulane students at Mardi Gras World.

“It’s the culmination of everything we’ve done through nine years of education. It all comes down to this,” Roach said. Having the decision out of his control was nerve-wracking but also added an element of excitement, he said.

“It’s the rest of your life,” said Joel Womac, who got his third choice and will be moving to Denver. Most residency programs last from three to seven years.

It would have been nice to have gone home to Oregon, his top choice, said an emotional Kate Womac, Joel Womac’s wife. But the couple said overall they were elated.

“And there’s drinks,” said Kate Womac, looking tearful and overwhelmed.

Sipping a frosted green Tulane mug full of beer, Michael Liu said he got his fifth choice, University of Southern California. He said he would have been happy with any of his top choices, including programs in Seattle, Chicago and New York. Liu called his time at Tulane “the best four years of my life — I’d do it all over again.”

He said he was sad to leave but excited to start the next chapter of his life.

For 34 of the 188 students matched on Friday, including Menal Jahm, Louisiana will remain home. The incoming class of 2013 had 27 Louisiana residents.

A native of Miami, Jahm said she was matched with Tulane Medical Center, her first choice.

“I love it here. I didn’t want to leave,’’ she said. “And I feel like there’s a lot of work to be done.”

Jahm said she was interested in global health and, in New Orleans, saw a place “where I could put my money where my mouth was and do that work in the U.S. as opposed to abroad.”

Statistics show a majority of physicians remain in the communities where they were matched for their residencies, giving increased importance of the day’s results in ensuring the continued feeding of Louisiana’s future physician pipeline.

At the Mercedes-Benz Superdome, LSU Health Sciences Center-New Orleans students received their matches at the same time as the Tulane students. Out of the 187 LSUHSC students matched Friday, 104 will remain in Louisiana.

Gov. Bobby Jindal’s move to privatize LSU’s public hospitals has not resulted in a once-feared exodus of medical school graduates going elsewhere for their physician training, said Steve Nelson, dean of the school of medicine at LSUHSC-New Orleans on Friday.

“We did well,” Nelson said, about filling slots at hospitals serving south Louisiana.

“There was a concern that all this disruption with health care redesign,” including talk of 10-bed hospitals and private partnerships, that the medical school graduates would opt to leave Louisiana, Nelson said. “There was a lot of concern in the early fall and winter.”

Nelson said developments since then “have calmed their fears” because the residents know they will get training in viable hospitals with a lot of patients as private hospitals take over operation and management of LSU hospitals.

“People from Louisiana are very loyal to the state. They want to stay here, but we have to give them a viable option,” Nelson said.

Of the LSUHSC-New Orleans students matched on Friday, 56 percent will stay in Louisiana. Dr. Charles Hilton, associate dean of medical education, said in the early 1990s, LSUHSC-New Orleans was hovering in the 60s and bottomed out at 45 percent after Katrina.

The LSUHSC-New Orleans accepted 138 new residents, including medical school graduates of LSUHSC in New Orleans and Shreveport as well as Tulane, the University of Mississippi, Georgetown University, Mt. Sinai, Drexel, New York University, the University of Alabama-Birmingham, University of Arkansas, George Washington University, the University of Texas-San Antonio and the University of Virginia, among others.

“Medical school is a hard and intense period of time,” said Benjamin Sachs, Tulane dean of the school of medicine. “It’s a maturation process, They come in just out of college, and now they’re going to take responsibility for peoples’ lives. Helping them on that journey is what it’s all about for me.”

Marc Kahn, Tulane professor and senior associate dean of admissions and student affairs, said Match Day is his favorite day of the year as he watches students make the next step in their lives toward becoming physicians. “It represents why they came to medical school.”