What happens when medical students don’t match

The National Resident Matching Program (NRMP), also called “The Match,” was created in 1952 to place U.S. medical school students into residency training programs.

Historically, osteopathic medical students could apply to the NRMP match program, but they could also apply to a separate AOA match program. However, the two match programs merged in 2020 as part of the transition to a single GME accreditation system.

Without going into great detail, let’s look at The Match process. First, you must register for the NRMP Match and then complete an Electronic Residency Application Service (ERAS) application.

The application

It is recommended that you apply for the Match in the December prior to the Match results, which are released in mid-March. The registration will include basic profile information, exam scores, and work and volunteer experiences. 

You should then research residency programs and try to perform clerkships at your top-choice residencies, if possible. You’ll apply to several residency programs, which will include providing letters of recommendation (LoR) from physicians who know you and have worked with you.

After the application process, you will be invited for several residency interviews (currently, the interviewing process has become virtual due to the current health situation in the U.S.) After the interviews, you will submit a rank list according to your preferences, and residency programs will rank their prospective residents.

Then, a complex computer algorithm will match both lists and the results will be posted. In addition to individuals who apply for the match, couples can apply together via the couples’ match. There are also several separate matches, including the military match, the San Francisco Match (ophthalmology and plastic surgery) and the urology match.

SOAP rounds

Those who do not match in the initial Main Residency Match can apply for the Supplemental Offer and Acceptance Program (SOAP). There are three SOAP rounds during Match week, in which unmatched students and residency programs can connect, and many applicants are placed into residencies this way.

A few reasons applicants may not have initially matched include an already filled program, the program not ranking the applicant, or the program withdrawing from the Match.

The moment a student learns they didn’t match is where the real stress begins. Every medical school has a clinical education department who works with each student from the beginning of the process through the emotional SOAP week.

Before we get into the specifics of SOAP week, let’s look at some statistics from the 2021 NRMP Match. The number of positions offered in 2021 were 38,106 and the number of positions filled in the initial Match were 36,179, which is an initial fill rate of 94.9%.

After the initial Match, 1,892 positions were placed in the SOAP round and at the end of the SOAP rounds only 119 total positions remained unfilled for a total residency position fill rate of 99.6%. The three reasons for positions remaining unfilled include the applicant preferring another position, the applicant not ranking the program, or the applicant withdrawing from the Match.

In 2021, 99% of DO fourth-years seeking GME were placed into residency programs, according to the American Association of Colleges of Osteopathic Medicine.

Since the funding for many residency spots comes from Medicare, it is difficult and will continue to be difficult to get lawmakers to make the number of residency spots match the number of medical students perfectly. However, we recently saw progress in this area when CMS funded 1,000 new residency spots in rural and underserved areas.

After the Main Match, the SOAP experience begins, and it’s an emotional one. Many students feel lost and embarrassed and begin to think that their medical career is over. Most COMs’ clinical education departments have been through this process extensively and offer extensive help and resources for those students. After the initial shock of not matching, students must grieve and then refocus.

As I have observed through volunteering, there is support from the clinical education department, the student’s friends and family, and other medical students from current and previous years. Preparation packets are made and distributed, and game plans are strategized for each individual student.

Support is available

I am an assistant professor at Touro University Nevada College of Osteopathic Medicine. Our school, like most others, provides rooms, nourishment, specific mentors, and electronic and computer support, as well as helpful tips on preparing personal statements and simulated interviews. Of course, the clinical education department will work with students from day one to help make the Match process as smooth as possible.

Students are encouraged to not only focus on their first choices, but also to expand their horizons and consider a transitional year or another specialty. Once students are accepted to a program, it is much easier to change programs within the same system or apply to another residency program outside their current program.

Even the few students who do not match in the Main Match or the SOAP match have options. The student should first find out why they did not match. Speaking with someone in your clinical education department or a trusted mentor will be helpful.

According to the Association of American Medical Colleges (AAMC), the top three reasons for students not matching are poor exam scores, poor academic standing, and poor interviewing or interpersonal skills. Begin by working on your weak areas.

If you are unable to secure a residency slot, other options include basic laboratory research opportunities, becoming a scribe, or working at your medical school as an instructor. You could also work in a clinical trials facility and/or volunteer at a hospital or clinic.

I remember one student who was so dejected after the Match that he would not engage with any of his friends or family for support. Our clinical education team tread lightly with this student at first, but by the end of the week we had come up with a strategy. He eventually wound up getting a temporary spot as an instructor at a medical school and successfully obtained an internship the next year!

The Match process is challenging, and the SOAP match is daunting, but remember that there are many people there to help you emotionally and strategically.

Related reading:

Cracking the Match: Everything a current (or future) residency applicant needs to know about the Match algorithm

Why you should consider living in a tiny home during residency