MATCH 2019: What happens when you don’t match?


Hello all MS4s. Congratulations to those of you who have successfully navigated the matching process. I fondly recall that day in 20xx then I matched and realized I could stay home with family and loved ones through my training. It was a truly blessed and overwhelming day. All of my work so far culminated in this moment of opening an envelope.

Some students have a different story. Some match a choice that takes them away from their home, loved ones and security, while others can return home. Other students found out this week they did not match. So what happens when someone doesn’t match?

The process is called SOAP: Supplemental Offer and Acceptance Program. It is a secondary match if you will, in which programs reach out to students via ERAS to match into their unfilled program spots. Unfortunately ERAS has been having technical difficulties for the past couple of days, leaving thousands of students wondering how they will navigate this process or if they match this year. My thoughts and encouragement goes out to each and every student coping with this. It’s hard enough to go through, but the uncertainty can be unbearable. Just know that you are worthy, you are capable and be determined to improve your application in your year off if need be. I recommend a research year, preferably paid if you can get it, applying to an NIH program for medical students such as the Medical Research Scholars Program https://clinicalcenter.nih.gov/training/mrsp/index.html

My thoughts on this are that things are different now than they used to be. There were approximately 42,950 applications to AAMC accredited residency programs in 2018-2019 vs. approximately 90,000 seats in medical schools. Granted there are 4 years of medical school, but even if you assume only 1/4 of those students graduate, you have 22, 500 people across specialties only accounting for US medical grads. https://www.aamc.org/download/321526/data/factstableb1-2.pdf

When you factor in medical grads from non US medical schools, students who didn’t match in prior years and consider what specialities are involved, the number of applicants easily outstrips the number of available residency positions. More residency positions should be made available as students invest so much time, money and effort to pursue medical school, and barring any glaring deficiencies, they should be able to earn their MD. Unlike other allied health professions such as nursing, there is no staging of degrees. You cannot practice medicine without completing a residency, but some alternatives include pursuing an MPH, policy degree, research career or working in industry.

A final thought to Match Applicants: There are many options, but whatever you choose, please do not feel sorry, embarrassed or ashamed of your journey. We (physicians) are here to support you and we are cheering you on no matter what path you choose.

Candice Williams, MD

Premed Consultants

What Is The Match?

UCLA Anesthesiology Class of 2012. aa77fa0e7e2471849ee1a7bf01791da22012_07_17_14_21_40.jpg

Hey there. I want to address the next step in the medical journey after medical school – Residency. How do you get there? It’s called the NRMP Match. It’s a national program that matches medical students with residency programs. US, International Medical Grads and Osteopathic Medical students can apply. In short, students apply to programs, through NRMP, they are granted interviews, then afterwards they rank the programs in order of preference. Programs rank candidates in their incoming class. On Match Day, medical students nationwide find out where they complete their medical training all at the same time. Most students have a ceremony that commemorates this monumental occasion. It’s a day full of excitement and emotions. The picture above is of my graduating class in Anesthesiology at UCLA. I’m the one in the black and white dress. I was so excited to be graduating finally and starting a career. I was so fortunate to Match  in 2008 as my first choice program.

What happens if you don’t match? Things have changed since my time, but now there is a secondary match called SOAP. Students can rank programs from various specialties and the secondary match will Match most students. For example, after about 30 k positions nationwide, after SOAP 2017, 101 spots remained unfilled.

In spite of these statistics, I encounter students from the US or IMG students who fail to match. How does this happen? Often time what hinders students from matching involves below average Step 1 score, any comments or disciplinary actions or needing to repeat portions of a medical school curriculum among other factors. For IMG, the reputation of their medical schools can be a barrier. Programs look more favorably on IMG candidates who have 1 year clinical experience, especially those who completed an internship in the US and are applying for PGY 2 positions.

Let’s go over some stats from the 2017 Match. The 2017 Match showed many US medical grads matched their top 3 choices but only 48% matched first choice. Also more IMG from US matched than ever before in terms of percentage (about 50%) but overall numbers were lower. The key is that they matched PGY1. For US IMG – You must get the internship. However the rates of matching into categorical Family of Internal Medicine (20% and 14 %) are higher than many PGY 1 only spots (about 6%). You could match a categorical IM spot then you can try to get a PGY 2 Position in your specialty of choice.

For anesthesiology, 74/1200 matched at US IMG. About 6% Chance. People faired much better matching internal medicine or Family. Internal Medicine, Surgery or Transitional PGY 1 are accepted by most anesthesiology programs, but as stated above these are competitive.

Here is the link to the Match Data.

http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf

So what are the take home messages and what can you do to improve your chances of Matching?

1. Mentorship is key. You need mentors in your specialty of choice to give you a realistic view of whether you’d match and how to improve your chances. These faculty members can give you concrete numbers you need and look at your application. These usually are at your institution if in the US, or if an IMG, connecting with a US program director to meet with you and give you an honest opinion would be key.  Ways to consider how to improve your application are research in the field, subinternships at reputable programs and letters from leaders in the field.

2. Having above board conduct and not too many academic red flags are important especially for competitive specialties. Programs do not want someone with ethics violations, problems following rules and order or those with academic problems. If you’ve had these, having additional research or clinical experience with people to vouch for you may help your situation. I found having 1 year of NIH research with pending publications greatly helped strengthen my application, and these programs are once in a lifetime opportunities. https://clinicalcenter.nih.gov/training/mrsp/

3. Audition rotations at programs of choice help. Most importantly performing well and forming relationship with leaders there help your case. If they remember you and like you, then you likely will match depending on specialty and competitiveness. This is general advice and every specialty has certain nuances to applying.

4. If you are an IMG, based on the numbers, it’s much easier to match Family or Categorical Internal Medicine. The key is to get your foot in the door. There are some IMG from US and outside who matched Anesthesiology. The rates were around 6-8% of applicants. These applicants likely were stellar in terms of their numbers. An above average and upper tier >235 Step Score is a must. If you are in the 218-234 range you have an uphill battle but it’s still possible. You must max out all applications in your specialty, all PGY 1 transitional, IM, Surgery and in my opinion apply for categorical IM and Family spots. The fact is specialties for US grads are competitive and more so for international grads.

I hope these tips help you all on your journey. Whether you are premed, first year medical student or are looking to Match, it’s good to know the process and ways to navigate it. IMG students don’t lose hope. This past year had a higher percentage of grads matching PGY 1 in a long time, and with some perseverance and strategic relationships you can navigate your way to success.

 

Best,

Candice Willams, MD

Premed Consultants

A Tale of Two Med Students

There was once a third year medical student, soft spoken and eager to learn. She was named Shy. She found herself on a surgical rotation with another student, we will call him Gunner.

Gunner was chummy with the residents from day 1. They laughed, joked, liked the same music and food. He stated he wanted to be ortho and one of the interns was pre ortho. They seemed like best buds.

Shy felt intimidated by Gunner. When they were on rounds he would steal the bucket from her and not let her dress wounds. He interrupted and spoke over her. Everyone seems to like Gunner and not her. She ignored this however, and instead of hollering at Gunner, she decided to study, work hard, and know her patients.

One day, New Attending came onto rotation. He was very important. Rounds were coming up. New attending asked Gunner to present his patient. He was unprepared, running late, said wrong information about his patient and gave wrong answers during rounds.

New attending turns to Shy and asks her to present. Shy presented her patient in an organized way and knew all the answers to the questions from New attending. He even asked her to give a talk later that day.

Shy later gave an impromptu talk, a summary of her prior talk that she did on another related rotation. New attending, interns and Gunner were all there. The interns seemed indifferent to Shy’s presentation, but New attending was impressed. He then let the group know that Shy has presented in the past and that she did an extraordinary job. Gunner seemed to look sad.

I tell this to illustrate a point. Gunner didn’t know that Shy knew New Attending from a previous rotation. Shy didn’t understand why Gunner put so much energy into sabotaging her, instead of working hard himself. Bottom line is, trying to sabotage your colleagues to look good is always bad form and unprofessional.

So, focus on making yourself the best that you possibly can be and Shine YOUR way!

Candice Williams MD

How to be a stellar 3rd Year

Hey beautiful medical students!

That’s right, I said beautiful. You have to be beautiful to take being called -“medical student” a million times and having to run here, there and everywhere. You are in the way, the lowest on the totem pole so they say, but really, you are the most important because you are the future of medicine! So, next time someone forgets your name, overlooks you, gets irritated when they have to pay attention to you or teach you – remember that you will likely take care of them or a loved one someday.

So, I just wanted to get past that point of being you being angry or resentful for being the last on the list to being considered. It’s not right, but it’s the way of the medical world. So how can you stand out, be noticed and at the same time, fly under the radar?

I have a few tips-

1. Be early! Yes I said it and mean it! On time is already late! I did not come up with that, that is from my previous professor of music- Sylvester Henderson. I won’t belabor this point.

2.Be prepared! Know your patients! Their history, meds, social history, pertinent changes in status etc. Look up major diagnoses on UpToDate

3.This also requires knowing and learning the flow of your floor or clinic and this has to be done quickly. Ask when you should come in the morning and leave. Ask what you can do to help the stressed out and tired interns. Try to be helpful, but don’t be obnoxious. By this, I mean, if someone is teaching you a concept, or a way to do something, don’t respond by saying – “I was told it was xxxx” in a snarky tone. I’ve had this happen and needless to say it didn’t bode well. In short, don’t be disrespectful to those teaching you, from intern up to attending. Please don’t act entitled or like you don’t have to work hard. Fact is, you do.

4. Work on your speaking skills. This means practicing your presentations, and getting used to answering questions on the fly. By reading on your patients and knowing them well, this helps you do better when questioned in rounds.

5. Don’t try to be someone you are not. This one can be tricky. As a student, I felt like I needed to be upbeat like one colleague, push someone out the way like another student did, or be loud and brash when I’m not by nature. I learned I can only be me, and whether or not people seems to accept me socially, hard work and knowing my stuff could not be argued. So I focused on these aspects, and I’m suggesting you do the same.

6.If given the chance, speak to senior residents or the attending early in your rotation to set expectations. Also, if you are interested in a specialty, tell them from day one, and put extra effort into learning about major subject areas in the specialty. Offer to give a talk on a disease your patient has for example.

7. Lastly – NEVER undercut or try to outshine a fellow student!

 

So third years, keep the faith, keep pressing, smiling and doing well on your rotations. Tell each one that you are interested in learning more about x specialty: this ensures you will be treated like you want to pursue it AND you will learn more.

Best of luck,

Candice Williams MD