Unsolicited Advice From Unmatched Residency Applicants: Hope For The Best, Plan For The Worst

When you enter medical school, you put your trust into an unspoken promise: Work hard, pass all your classes, and you’ll come out as a doctor after four years. While mostly true, this perception doesn’t take into account the residency application process and the possibility of graduating without a position as a physician-in-training. This thought didn’t cross my mind until I decided to apply for otolaryngology, one of the most competitive specialties. I went into the application season hoping for the best, knowing that the number of applicants was higher than ever. On the Monday of Match Week, I opened my email from the NRMP to be met with the words, “We’re sorry, you did not match into a residency position.”

The hours after receiving the news were a whirlwind. Within that short period, I had to figure out what my plans would be for the next year while grappling with feelings of disappointment and failure. At the same time, texts were flooding in from friends and family asking about the result. The two words that most captured how I felt were “overwhelmed” and “isolated.” Going unmatched comes with the stigma of having not performed well academically or having a significant red flag in the application. I had no desire to broadcast my news and felt uncomfortable reaching out to others to see if they were going through a similar experience.

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However, I wasn’t alone in my feelings. In 2021, the overall match rate of U.S. MD seniors was 92.8 percent. At face value, these odds look good, but the story is very different for students applying to certain competitive specialties. Students who only applied to otolaryngology, orthopedic surgery, or plastic surgery matched at a rate less than 80 percent. In other words, at least 1 in 5 students applying to these specialties went unmatched. Most of the time, these are students who have excelled academically and carefully crafted their medical school experiences in preparation for a competitive residency application. How do you guide and comfort these students as they tackle what is arguably one of the most challenging moments that one can face as a medical trainee? My colleague and I asked ourselves this very question, and after reflecting on our personal journeys and hearing the stories of many others in similar positions, we are writing this post for any individual applying for a residency position, especially one that is competitive.

As you’re preparing your application, gauge your odds of matching. This can be done by reaching out to mentors and looking at objective sources such as the NRMP’s Interactive Charting Outcomes in the Match. While you’re having these conversations, recognize that faculty mentors’ impressions may be somewhat biased based upon their perspectives on the level of competitiveness of the field. For example, expressing that a candidate will match without a shadow of a doubt can give applicants a sense of overconfidence. Seeking out a variety of opinions can only stand to benefit you. Moreover, you should take time to brainstorm alternative career paths. Are there any other fields in which you might also be happy? If you were to go unmatched in your specialty of choice, would you rather have a residency position in another field or would you want to reapply? Though it requires additional time and planning, dual applying is an option that should be seriously considered and discussed with mentors. Of course, the decision to dual apply is a personal one that weighs several factors such as career goals, personal finances, risk tolerance, and other life priorities.

Once you’ve already submitted your application and are going through the interview process, we highly recommend developing a plan in the event that you do not match. This was arguably one of the most important factors that helped us through SOAP week. No matter how many interviews you have received or how likely you are predicted to match, there are always factors that can’t be accounted for in the process. Introspect and seek out the opinions of mentors on the following questions: If you were to hypothetically go unmatched, what might be the reason? If it is an element of your application that you cannot fix (such as low board scores or grades), would it make sense to reapply? If you choose to reapply, would it benefit you to take a research year or to SOAP into a preliminary position? Make an active effort to have an honest discussion but realize that mentors have different strengths, and some may feel more comfortable than others in having this conversation.

Finally, as you develop this plan, keep in mind a few remaining logistical considerations. Some students choose to delay graduation, but that is not an option for everyone. Check with your medical school as to whether they require tuition payments and/or what your obligations might be regarding repayment of student loans should you choose to delay graduation. Perhaps most importantly, think about who you can look to for support if you were to go unmatched. Ask yourself: Who can I rely upon to best support my mental health and guide me through life-altering decisions during this moment of high stress and vulnerability? Ultimately, whatever plan you create will be a personal decision.

We hope that in reflecting on these questions, you are well prepared to face whatever may happen during Match Week. Even though our original plans were disrupted, we are happy to report that this year has already led to significant personal growth. So, no matter what may occur during Match Week, please remember this — your worth is not defined by this outcome. The countless hours spent studying or conducting research will make you an amazing doctor, regardless of what career path you end up pursuing. Best wishes to everyone applying.

Katherine Yu and Shaan Somani are clinical research fellows.

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