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some medical students didn’t match into a residency

It’s almost over.  The search for a residency program.  We’ve talked about the pains of traveling for residency interviews, of getting stuck in snow storms, of getting our luggage lost, of crashing planes and of the flaws in the process.  And now it’s almost over.  But not over yet. 

This past Monday medical students found out whether we matched or not.  First of all, if you know someone who didn’t match into a residency, make sure you give them some love.  For the vast majority of us, this process is a real crap-shoot.  Unless you’re one of the chosen few, the rest of us are on pins and needles from November to March with regards to getting interviews, to matching and to where we are matching. After four years (or more if a student took time off to do research or earn another advanced degree) of hard time, it would be great to end it all with a parade and a pat on the back but that’s unfortunately not the case.  But it can be particularly rough when it ends without matching into a residency. 

I received good news but I also know a lot of good, smart and talented medical students who didn’t.  I was in touch with one person who I was sure would get into one of the top residency programs in my field but found out that he didn’t match.  It just makes you shake your head, and unfortunately it leaves him and other unmatched medical students with tough choices to make.  In fact, he asked me, “what would you do if you were in my shoes?”

There are really two options: (1) scramble or (2) take a year off and reapply next year.  Every year, residency positions in all fields go unfilled at random programs across the country and these are up for grabs by applicants who didn’t match.  “Scrambling” is when unmatched medical students try to get into these unfilled residency positions.  The upside of scrambling into a residency is that the student would get into a residency.  The downside of scrambling is that the student would probably get into a residency program of low quality (these are usually the ones who can’t get enough medical students to rank them) and the student may not even get a residency in the field he applied in. 

So given these choices, what would I have done?  I’ve been thinking about this for a few days now and I think it comes down to a few factors:

  1. Temporal factors (such as the applicant’s age) that would affect whether the applicant would be willing to delay his career by one more year
  2. How much the applicant wants to go into his field of choice, relative to the next best option
  3. How realistic is it that the applicant can actually match into his field of choice

So let’s breakdown each of these factors. 

  1. Some medical students will already have taken significant time off–or rather, will have done something outside the track to residency.  I did a PhD.  While not exactly time “off”–I was working (although some people would argue about that)–my time in graduate school did not move me any closer to residency.  Other medical students take a year or two off to do research or pursue a masters degree during medical school.  Some medical students will have taken substantial time doing something else between college and medical school.  In my first year medical school class, we had at least 4 30+ year old people.  In contrast, I was 22 years–fresh out of college–at the time.  These factors can clearly impact how one chooses which option to take after not matching.  If it is simply not realistic to delay ones medical career any longer, then the applicant has to scramble and hope for the best.  If the applicant hasn’t taken any time off at all, then taking a year off and reapplying may not be a bad idea.  Most applicants are in the middle of these two scenarios so the decision is also affected by other factors. 
  2. Some medical students couldn’t imagine practicing any other field of medicine besides [insert field here].  I know one guy in the year below who was born to be a neurosurgeon.  Everything about him screams neurosurgeon.  He will probably match into his choice of neurosurgery residency, but if he didn’t match at all, there is no way this guy would scramble into a residency program that wasn’t neurosurgery.  No way.  Then there are medical students who can barely make up their minds because they really love two different fields of medicine or, on the flip side, don’t really find any particular field to be really appealing.  One of the things we do for residency interviews, regardless of our baseline interest, is to pump up our own perception of how much we love the field to which we are applying.  It’s necessary for the interviews.  But if even after all of that, you can see yourself practicing a different field of medicine, then your options for scrambling are even better.  Alternatively, if you take a year off, you could reapply in a different field if you are worried about getting into a “top” program. 
  3. Finally, I think if you don’t match–just like any other unmet goal–you have to consider whether the residency (field or particular programs) you are shooting for is realistic given everything (your grades, board scores, etc).  I think it sucks to come to this, but it’s a fact of life.  At one point I realized that I would never slam dunk on a ten-foot basketball rim.  It broke my heart, but there you have it.  If you feel like it would be a stretch to match into that particular specialty, then consider taking a year off and matching into another field (see #2 above), albeit a better quality residency program.  Otherwise, just scramble into the best place you can land.  If the programs you applied to are unrealistic but not necessarily the field itself, then you could take a year off and reapply to more realistic programs, if you couldn’t see yourself practicing a different field of medicine.  If you are scrambling, then you are probably still a competitive enough candidate (although maybe not competitive for the top, top residency programs) that you could get a decent unfilled residency slot somewhere, if you would be okay with perhaps practicing a different field of medicine. 

So, I think those are the 3 main factors that need to be considered when deciding whether to scramble or give it another go next year.  And that’s why I, or anyone else, can’t really offer helpful advice–only the medical student can sort through all of that. 

For me personally, I’m too attached to the field I’m applying in.  Plus I’m pretty stubborn so I would in general be on the side of reapplying the next year.  Even with having taken 4 years ”off” to do a PhD.  But one thing I will say is that if you do take a year off with the intention of reapplying, then make that year count.  Do something that will significantly add to your CV.  Join a research lab related to the field you are applying in.  Work with someone on some public/health policy initiative.  Do something that you can talk about at your interviews.  Clearly I don’t know about all possibilities, but if you can dream it, then there’s someone out there who will work with you.    

Best of luck to you my friends.

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3 Responses to “some medical students didn’t match into a residency”

  1. 1
    Tara:

    good thoughts,

    I didn’t match this year. I had a 3.9 GPA, great LOR & 99% on the step scores. But I am an IMG and I guess that screwed everything up. I rotated at the hospitals I ranked top 3; and these were in different states so it was a total pain in the *** to travel around the country. Anyways, I am going for intternal med in South where no one is interested because the thought of not matching next year really disturbs my stomach.

  2. 2
    IMG Matching Success Ratio; What are the odds! - USMLE Forums:

    [...] study or research programs if you’re in the states. Here are the references for further detail: http://www.mudphudder.com/2009/03/so…o-a-residency/ http://rookiedoctor.com/blog/2010/03…should-you-do/ Good [...]

  3. 3
    R:

    Tara, how did you end up liking IM in South? I would love to hear more about your experience.. would you be up for phone convo? (Currently an MS4 and not a creep.)

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