Ending Match Day without a residency doesn't signal the end of your career, even if it may feel that way at first. "To get to that point and want to match, and not match, can be a moment of deep disappointment and a lot of soul searching," says Rael Mazansky, MD, who cofounded the Drop Out Club, a website for students who leave medicine. "It can be a moment of deep despair as well; you spent the past 7 or 8 years preparing for this moment and it doesn't arrive." According to the National Resident Matching Program (NRMP), more than 26,000 students matched in 2016, including 1022 during the Supplemental Offer and Acceptance Program, which occurs in the days following Match Day. Those students together filled 99.5% of the available positions. But nearly a quarter of students ended Match week without a residency—8640, to be exact. The most competitive specialties were reported to be dermatology, orthopedic surgery, radiation oncology, and vascular surgery. While the future is set for those who match, some students who don't match decide to leave medicine altogether; others regroup and reapply a year or two later. "I took probably 1 to 2 weeks to myself, just accepting the fact that I didn't match," says Wilnise Jasmin, who later reapplied and had success. Jasmin is now a chief resident in family medicine at Loyola University Medical Center. What comes next for those who finished Match Day matchless? Making the Next Move "Do some soul searching to see what you really want to do," says Chandler Park, MD, who advises students at the University of Louisville School of Medicine. "It really boils down to prioritizing what's most important." If a student has his or her heart set on a certain specialty but didn't get into that specialty during the initial match, Park recommends casting a broader net by looking for unfilled PGY1 internships in a program that also has a residency in the desired specialty. From there, the student can try to make a good impression on the program director. "During the internship, you have to impress the attendings by coming in early and staying late. It is an audition for a strong letter of support and also an audition to stay at that program." He cautions that you have to make your impression quickly because you will be applying again by fall. Most students must reapply later if they still want to do a residency, and they should consider either a less competitive specialty or a broader geographic range. Jasmin originally listed about a dozen family medicine residencies in and around New York City, where she is from. When she applied again the following year, she expanded her list to about 50 from all over the country. According to the National Resident Matching Program, the average applicant who matched listed 10.6 programs. The average unmatched applicant had only 4.7. Applying to a long list of programs doesn't come cheap, of course. "Get over the shock as quickly as possible," Jasmin advises. "Start working. You'll need the money." She began by asking her school's alumni office for advice on how to strengthen her application and also asked for feedback from her top-choice programs. She also attended a residency fair and made a point of talking to people from various programs. Over the following months, she kept in touch with the people she met there, in hopes that they would remember her when they saw her application. Many students who intend to reapply look for a research program, but Jasmin was concerned that a research project might take more than a year to complete. She had a business background, so she chose to look for a job in hospital billing. She worked as a clinical documentation specialist, reviewing charts to make sure that they were documented properly for billing. Alternative Careers Some medical students end up in nonclinical careers in the long term, too. Mazansky's Drop Out Club is a hub for them. Mazansky went to medical school at Columbia but chose not to enter the match. He says he already knew at that point that he would prefer a career in business and now holds both MD and MBA degrees. The Drop Out Club grew out of a group of friends who had ended up in careers outside of medicine for various reasons. At first it was social, but the group grew larger and the friends began to pass around job postings that might interest other members. In 2008, the website for the Drop Out Club officially became a job board. In 2016, it acquired a similar service for PhDs called Oystir. Employers find these boards useful, Mazansky says, because quite a few jobs outside of medicine are perfect for people who have MDs but not necessarily any clinical experience. By far the most popular type of job he sees, making up what he figures is between 25% and 40% of postings, is in sell-side equity research. This is typically a job at an investment bank, where research analysts are needed to keep an eye on a certain part of the industry in which the bank might consider investing. The bank has a team that assesses information regarding the companies they are interested in and has them write reports for investors. To research healthcare, medical, and biotech companies, an analyst with a medical degree is a great candidate. Because the job does not require any clinical experience, a residency is not necessary. The next most common job Mazansky sees on the Drop Out Club is medical consulting. Consulting firms provide advice to companies, and the field is varied. Consultants may end up advising companies in the scientific, medical, or healthcare industries on any of a wide range of topics about their business strategy or details about how they run their business. Another avenue for people with a medical degree but no residency experience is legal-medical consulting. In this field, a person might act as an expert witness in court cases or as a legal-medical liaison. The Drop Out Club is sponsored by a company that offers law and business courses to medical school graduates looking to get into this field. Life Beyond the Match In short, people with medical degrees are valuable to various businesses whose work involves medical or scientific fields. Park points out that the information technology companies that develop electronic medical records systems need people with medical expertise; pharmaceutical companies also need such individuals for various jobs, such as research and writing related to clinical trials. So if you fail to match into a residency, or, if like Mazansky you choose not to enter the match, there is a wide array of options for alternative careers and even some chances to get into a residency later. "At the end of the day, not everyone can get the field that they want in their geographic region of choice. One has to compromise," says Park. And compromise may well lead to a happy career. Source
