What to do if you don’t Match into residency

Every year, on a Monday in March, tens of thousands of prospective medical school graduates receive a much anticipated email. The email tells them if they successfully secured a spot for the next step in their medical career: residency. This is known as “matching.” For the vast majority of medical students, matching into residency is the primary focus of medical school. For most, (91.3% of DOs in 2022), the email will come indicating that they matched.

However, a small percentage of applicants will learn that they did not match. For most who experience it, not matching is remembered as agonizing, stressful, difficult, and in many cases, shameful and traumatic. Those who don’t match often feel disoriented, discouraged, discarded, and in disbelief. The lack of accessible, mainstream information on the topic only worsens these feelings. 

I believe not matching is often not written about because of the culture of our profession. Physician-hood demands excellence. Just as matching is the pinnacle of achievement for medical students, not matching can easily be perceived as the epitome of failure. It is no small wonder, then, that the culture of physician-hood drives those who do not match into silence. 

I would like to break that silence today. My intention is to provide insight and hope for those who may experience the misfortune of not matching. This column is not intended to describe the intricacies of the sequence of events following not matching. There are already sufficient sources on that topic.

In preparation for this article, I interviewed six individuals who experienced not matching and included feedback from my own experience of not matching. These individuals, including myself, have all subsequently joined residency programs in various specialties (i.e., radiology, surgery, family medicine, and pediatrics), and I have codified and quantified their interviews to identify the top pieces of advice. The two basic categories of advice in this column address preventing a non-match situation and navigating it when it happens. 

Advice on preventing not matching

Interestingly, the advice provided by the interviewees on preventing not matching is not unique. The two most frequent pieces of guidance given by these interviewees were to:

(1) cast a wide net, and

(2) be realistic about how competitive your application is. 

In a previous column, I interviewed 38 former applicants who successfully matched into their #1 ranked residency program. The top two pieces of advice provided by these successful former applicants are the exact same. Be sure to check out the column, where those specific pieces of advice are described in more detail.

How and what to feel

Advice on navigating not matching

Speaking to the emotions surrounding not matching was the most common item brought up during these interviews. Interestingly the two most common pieces of advice in this category were to allow yourself to feel negative emotions, but do not allow them to stop you from moving on and taking the next steps needed to further your career.

The first was regarding the initial emotional impact of not matching. Several interviewees stated that as long as it does not hamper the ability of the applicant to pursue next steps in a timely and professional manner, it is OK to be unhappy. It is OK to feel the expansive spectrum of negative emotions that come following not matching.

Validate negative emotions. Those emotions do not need to be hidden, rationalized, downplayed, or avoided. Objectively, not matching is a devastating experience and it can be treated as such. If you ever have thoughts about harming yourself or ending your life, please reach out to a trusted friend, call the suicide hotline number (988), or go to the nearest emergency room. 

However, after interviewees expressed the above sentiment, they followed it with this: once you have allowed yourself to feel the pain and unhappiness, it is time to move on and be hopeful and positive. Do not allow despair and discouragement to haunt your forward progress indefinitely. Remember, this is coming from several previous applicants who all experienced not matching, and then subsequently joined residency programs in a wide variety of specialties.

Yes, not matching is a setback, but it does not have to be a career-ending or even a career-defining event. Yes, the path forward may not be as conventional or predictable as many applicants may have hoped, but the path forward can and often does include being placed in a great residency program. Many programs happily consider reapplicants, and many programs have faculty and staff who themselves experienced not matching. 

Know what your priorities are

Interviewees often expressed that it is important for applicants to know what their career priorities are. This is something that all applicants should consider before the Match, and while considering the previously mentioned advice of being realistic and objective about how competitive they are as an applicant. 

What needs to be done is a cost-benefit analysis. Applicants—in every stage of applying to residency, especially if they do not match—need to consider their desired specialties or programs and analyze the cost of achieving them. Then they need to decide how much of that cost they are willing to incur. 

If an applicant does not match into the competitive specialty of surgery, for example, but is committed to becoming a surgeon and is willing to incur the cost to achieve that, then their priorities are well-defined. That path forward may include a structured and productive gap year filled with research, a transitional/prelim year, and aggressive outreach to surgery programs in preparation for the next application cycle.

Conversely, if an applicant does not match into surgery but is also content with being an internal medicine or family medicine physician, the path forward might include participation in the SOAP and joining one of these programs during that same application cycle. 

Another thing to note is that many programs consider applicants who switch specialties. Many programs have faculty and staff who have switched specialties themselves. 

Regardless of what an applicant’s priorities are, it is best if they can be defined before the Match occurs. All applicants, regardless of their probability of matching, should have well-defined priorities and contingency plans. 

Remember to retain perspective

A common phrase or notion expressed by the interviewees was to “Remember the big picture.”

The point interviewees were trying to make is fairly clear. Students need to remember to retain perspective. Students should prioritize fostering sources of satisfaction, meaning, and purpose outside the result of the Match. These sources are important for all med students and will be imperative for those who do not match. If applicants do not match, drawing upon these sources, especially during the acute phase of not matching, can be absolutely crucial.

Related reading:

Rules to rank by: Creating your NRMP Match rank order list

7 tips on letters of intent for residency applications