AMA News Wire
What I wish I knew about matching outside my top-ranked choices
Mar 13, 2024
For many residency applicants, Match Day can mark a joyful end to a taxing process. For the vast majority, that is because results align with expectations.
Last year, nearly half of students from allopathic and osteopathic medical schools matched at the top choice on their rank-order list, and about three-quarters matched to one of their top three choices, according to data from the National Resident Matching Program. But what about the other one-quarter of applicants?
AMA member Deena Kishawi, MD, was in that group as an applicant in the 2019–2020 residency selection cycle. Dr. Kishawi—now a fourth-year ob-gyn resident at Ascension Saint Joseph Hospital-Chicago—matched at the fourth choice on her rank-order list.
A dual applicant, Dr. Kishawi didn’t match in orthopaedic surgery, the specialty she had atop her list. Her connections—through experiences such as physician shadowing, scribing and away rotations—to some of her top-ranked programs predated medical school in some instances.
Matching lower on her rank-order list made for some disappointment on Match Day and the weeks after. Ultimately, however, Dr. Kishawi, described the experience as a blessing in disguise during an interview with the AMA.
Reflecting on her transition from medical student to resident, Dr. Kishawi offered some insight for medical students on what she wishes she knew about not matching with one of her top choices.
Be ready for a curveball
Dr. Kishawi ranked seven residency programs in total, and after learning she matched with her fourth choice, she was “incredibly disappointed. To this day I do not look back at Match Day stuff because you could see the disappointment and the sadness in all of my photos. Well, I also matched during the first weeks of COVID, so that was part of it too. The entire city of Chicago was shut down.
“I had put all of my eggs in one basket in terms of the excitement and hope to be at this one place. And then I obviously didn't end up there. It took me a couple of weeks to finally come to terms with the fact that I didn't match there, or I didn't match ortho, or the fact that not even just matching ortho, but not even matching in my top OB program,” said Dr. Kishawi, who earned her MD from Loyola University Chicago Stritch School of Medicine. “I felt a lot of disappointment and it felt like I wasn't successful despite having matched.
“I felt like I didn't do what I needed to do as a medical student to succeed. I think maybe also with the social isolation, it took a very long time for me to finally be like: OK, you know what? I matched. I'm very thankful for matching and I matched with a program that I'm familiar with and I hear good things about. So we'll see what ends up happening."
Keep an open mind
“I always tell students when they're coming towards Match, the fact that you match is a huge accomplishment in and of itself,” Dr. Kishawi said. “You don't want to pigeonhole yourself into one specific program because regardless—once you do that—you will get disappointed. And even if you match at that program, you will always have a little whisper in the back of your head saying, ‘What if I matched at a different program?’”
Dr. Kishawi ranked an orthopaedic residency program as her No. 1 choice.
“Being so confident in that one program led me to ignore all of the good things about every other program that could have potentially altered the way I made my rank list and where I ended up matching,” she noted. “When you are so strict or you're so confident in matching at one program, you set yourself up for disappointment.”
Doing so can “strip away the excitement of Match Day because although you matched, you're so disappointed in yourself for not matching at your No. 1 that it feels like you didn't even accomplish anything,” Dr. Kishawi said. She added that “is such a horrible mindset to have when you have successfully gone through four or five years of medical school, and you finally get to this ultimate moment where you have seen the fruits of your labor.”
Dr. Kishawi advised that residency applicants should make sure that each choice on their rank-order list is a desirable program.
“You might not end up going to your No. 8 or your No. 12 program, but you need to be OK with the fact that if you match there, you will go. You shouldn't be disappointed in yourself if you match there, and you shouldn't be surprised if you match there.”
Put things in perspective
“One thing that changed my outlook was there were so many of my friends who didn't match, and I didn't learn about it until graduation day when they put up all of the locations of where everybody is going to for residency. There were at least five or six of my friends and classmates who didn't match anywhere.”
It was then that Dr. Kishawi truly appreciated her good fortune at having “matched at a program that I had already interviewed at and had already seen in person,” she said. “And this wasn't me changing my specialty to something I had never considered or ending up in a random city that I had never visited. I matched at a program that I had applied to and that chose me and interviewed with me.”
“I matched in the same city that I went to medical school in, which was really great because with COVID when I was getting bored and the weather was getting nice, I just drove around the neighborhood that I matched at just to get a better idea of the layout of the hospital and everything in the area,” Dr. Kishawi said. “And I think the more that I was there, the more I started to feel comfortable with the area and that's really what made me less disappointed in my Match outcome.”
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Avoid the name game
“I came from a very large academic medical school, and I matched at a small community hospital. I didn't have a lot of experience with community hospitals prior to my match,” Dr. Kishawi said, noting that part of her disappointment was failing to match at a program with an institution “that had a big name or a big reputation.”
Having been part of the small ob-gyn residency program at Saint Joseph Hospital-Chicago for nearly three years, Dr. Kishawi has come to deeply value its pivotal role in the community.
“The more that I have worked in this hospital, the more I hear things like: ‘Oh, my mom delivered here. Oh, my brother did surgery here.’ And it really is this small, close-knit community that comes to this hospital, and we all serve this Chicagoland community as well.”
One benefit to training at a community hospital with a small ob-gyn residency program is the lack of fellows.
“It's not like there are other people who can take our cases for the more specialized surgeries. So, for ob-gyn cases, when I'm a third- and fourth-year, I'm the senior resident. I'm the primary surgeon in those cases,” Dr. Kishawi noted. “For C-sections, we're doing them as early as our first month, maybe even our first week of residency. Those are experiences that I know are a little bit more unique to community hospitals because of the culture and the environment and the volume.”
Love the program that loves you
One piece of advice that Dr. Kishawi got from her residency program director has stuck with her.
“You want to go to a program that loves you and that wants you, because that sort of symbiotic relationship will help you succeed,” she was told.
That outlook helped change Dr. Kishawi’s own view of her Match experience.
“I ended up at a program that wants me, they saw potential in me, they were excited to have me,” she said. “That's why they ranked me highly, and that's why I ended up where I ended up.”
That perspective really “changed my disappointment to a lot of excitement and being grateful for where I ended up.”
