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Not Matched? The Decision to Reapply

Written by Ugo A. Ezenkwele, MD, Resident, Department of Emergency Medicine, Hospital of the University of Pennsylvania

It’s two days before Match Day at exactly 12:00 pm and you receive the dreaded call from your Dean. You did not match. Uh oh! What do you do now? Should you scramble for a spot in an unmatched residency program, apply for a one year research grant giving yourself time to reassess, or throw the towel in entirely and give up the hope of ever becoming a physician? These are tough decisions to make and you have 48 hours to make them. What do you do?

Fortunately, you are not alone. In 2000, the National Residency Matching Program (NRMP) offered 20,598 first-year positions among 3679 programs. 25,462 applicants participated and of these, eighty-nine percent matched. Among those who did not match were graduates of US accredited medical schools, former graduates of US medical schools, US osteopathic students, Canadian students and graduates of foreign medical schools. Therefore, throughout the US and the world, people like you are faced with the decision of what to do.

Let’s look at some options: 1) The Scramble for an Unmatched Spot; 2) A Year Off; and 3) A Life other than Medicine.

The Scramble for an Unmatched Spot
After you have received the call, your Dean will provide you with a list of programs with open residency positions. Your task will be to call these programs, find the one most favorable and submit your name. The key is to be prepared. Make sure you own a fax machine or have access to one. Furthermore, have someone available (either a spouse, friend or colleague) who will help you with the process of contacting residency programs. As soon as you know the unfilled positions, download the contact information and start phoning. The key is to start with the programs you already interviewed, then proceed to other programs in your specialty in a favorable geographical location. If the program agrees you may use the ERAS application service. If not, fax or email your applications immediately!

If you are fortunate you may end up in a program in which you interviewed or one within your specialty. Advantages are you have a job, especially in the field you are interested in and at the end of it all, you will be a medical doctor. The disadvantages are you may end up in a specialty that is different from the one you are interested in and/or you may end up without a job. Some people will opt to undertake a transitional or preliminary position in medicine or surgery for a year that will allow them to re-enter the match the following year.

The key with the scramble is to be prepared. The possibility of not matching can happen to anyone and not being prepared can result in others in a similar position making off with choice residency positions.

A Year Off
For some people, a year off is an excellent opportunity. During that period most will spend time bolstering their resumes either with research projects, volunteer exercises, and/or extra degrees (e.g., a masters in business, public health, or the sciences). It is imperative that you spend this time wisely. During the following Match period, most residency directors and/or or program directors would like to know what you spent the extra time doing.

People do not match for various reasons. Whether you set your sights too high, or you ranked too few places, or you were "deceived" into believing you had a spot, etc, the reality is a year off is not the time to travel the world. It is the time to strengthen your application and make sure history does not repeat itself.

Furthermore, being prepared is also important if you choose this option. Recognize that applying for research positions or graduate programs require a lengthy application process with letters of recommendation, personal statements, and/or project proposals. Fortunately, much of this you have prepared already. However deadlines may have passed. Therefore, being prepared with appropriate contact information, knowing whom to call for an immediate response and being able to identify an appropriate research mentor would be helpful toward ensuring a successful year off.

A Life Other Than Medicine
You have come this far and dedicated nearly a decade of your life toward medicine. I would advise you to persist and continue toward a career path in medicine. Do not let the fact that you did not match become a deterrent toward that goal. If you scramble and/or take a year off to try again, chances are you will persevere. However, if you decide to discontinue for any number of reasons there are multiple other fields related to medicine which look for students who have graduated from medical school. These include: consulting, health care research firms, investment banking companies, health maintenance organizations, and non-profit organizations. Your options are open.