Preparing for Residency

Match Week FAQ: How to move forward when you don’t match

. 14 MIN READ

AMA News Wire

Match Week FAQ: How to move forward when you don’t match

Feb 21, 2024

It’s the worst fear come true for fourth-year medical students, international medical graduates (IMGs) and other residency applicants: not matching with any of their chosen ranked residency programs. People who don’t match initially are likely to ask themselves questions like:

  • What do I do now that I haven’t matched?
  • How do I get the medical training I need to move forward with my career?
  • Will preliminary programs help me get to the specialty I want to practice?
  • How does the Supplemental Offer and Acceptance Program (SOAP) work?
  • Will I be taken seriously as a physician if I match through SOAP or after a prelim program?
  • What if I still don’t match after SOAP?

But not matching the first time around hasn’t stopped countless physicians from long and rewarding careers. The road to a fulfilling career as a physician requires resilience, creative thinking, bold actions, and ultimately unwavering faith in oneself—even after not matching. 

The guidance below is drawn from a webinar hosted by the AMA in which several physicians, including current residents and program directors, shared a wide array of perspectives on what to do if you don’t find success on Match Day.

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The panelists were: 

John Andrews, MD: University of Wisconsin alum, pediatrician in Chicago, former residency program director for pediatrics. He's a former associate dean for graduate medical education and designated institutional official. Now the vice president of graduate medical education innovations at the AMA.

Louito Edje, MD, MHPE: senior associate dean for medical education at the University of Michigan Medical School. In the role, she supports 1,300 residents and fellows across all specialties, as well as 680 medical students. Prior to her current role, she was designated institutional official supporting 100 graduate medical education programs, was a program director for eight years, and she founded two family medicine residencies.

Daniel Lee, MD: neurology resident finishing up his intern year at the University of South Alabama. He graduated from the University of South Carolina School of Medicine, Greenville, and previously served as vice speaker of the AMA Medical Students Section. Dr. Lee now chairs the AMA Resident and Fellow Section’s Committee on Medical Education.

Tani Malhotra, MD: maternal-fetal medicine, physician and assistant professor of reproductive biology in Cleveland. She graduated summa cum laude from the American University of Antigua. She previously served on the Society for Maternal-Fetal Medicine’s board of directors. She also chaired the AMA-RFS and now serves on the AMA IMG Section Governing Council.

George A. Sarosi Jr., MD: vice chair for education and surgery residency program director at the University of Florida College of Medicine. He also is a professor in the surgery department. Dr. Sarosi graduated from Harvard Medical School and received surgical training at the University of Michigan Medical Center, where he also completed a two-year gastrointestinal surgery research fellowship.

Aaron Wolbrueck, DO: a captain in the U.S. Air Force, and an internal medicine resident at Tripler Army Medical Center in Honolulu. He is a graduate of the Texas College of Osteopathic Medicine.

“If you have issues with your test scores or with your grades, you can't change those by reapplying in the Match,” said Dr. Sarosi. “Those will still be the same the next year. But what you can do is work in a training program. Be the best intern in that training program and get a bunch of allies who are going to help you rematch.”

“I was graduating at the top of my class,” said Dr. Malhotra. “I had high scores. I had good letters of recommendation. And I didn't apply to any prelim positions, because I thought I could do better than that. I wish I'd applied to prelim positions my first year. Just because you go into a prelim position doesn't mean you're any lesser of a doctor or not good enough.”

“I have a colleague who is the ... chairperson of a major department of surgery who started their career in preliminary surgery,” Dr. Sarosi noted. “This person has an amazing career. So, just because the first year doesn't work doesn't mean that you're not going to be amazingly successful in your chosen career. Don't give up.”

Go further: What if you don’t match? 3 things you should do

“I made this massive spreadsheet of all the programs I applied to the second time,” said Dr. Malhotra. “I then called all of the programs I didn’t hear back from and crossed them off my list one by one. I even left one a voicemail and, sure enough, they interviewed me.”

“Some of the most resilient applicants are ones who come through SOAP,” said Dr. Edje. “And really some of the most amazing physicians that I've met have a history where they've gone through so much challenge. They're empathetic. They are great mentors. They're phenomenal people, and usually highly compassionate with patients as well.”

“The process is not about finding the perfect program, it’s about finding a pathway forward,” said Dr. Andrews. “Program directors have a radar for genuine interest.”

“Traditionally, we think SOAP is for people who weren't good applicants,” said Dr. Lee. “I've seen plenty of applicants who were fantastic through SOAP, and you know sometimes the initial Match system just doesn't work for everyone.”

“In applying to the SOAP program, you have to be clearheaded about what you want,” said Dr. Andrews. “When SOAP resolves favorably with an offer to join a residency program, it’s a commitment. Don’t just desperately seek a position, any position, because that could be a recipe for being really unhappy in your training.”

“Make sure that you understand what you really want to get out of matching,” added Dr. Edje. “Write out personal statements for each of the specialties you’re considering and you’ll be more prepared for other potential outcomes.”

Learn more about SOAP: Which specialties place most residents through SOAP

“Some schools, for example, will allow you to graduate a year later,” said Dr. Andrews. “They'll keep you on and allow you to graduate and be in a more competitive applicant group, as a result, for the ensuing year’s Match.”

“The Air Force as well as the other military branches recommend at least applying and getting interviews for prelim positions and civilian positions just in case,” said Dr. Wolbrueck.

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“I can tell you that if I call you tomorrow, the first thing I’ll tell you is how sorry I am that you find yourself in the SOAP,” said Dr. Sarosi. “And then the second question I'll ask you is: ‘What do you think happened? Why do you think you didn't match in the specialty that you applied in?’ And if you can't give me a well-thought-out answer, it's going to be a pretty short phone call.”

“Unlike the original Match, they will ask more specific questions,” said Dr. Edje. “‘These are questions that are trying to get at the root of your authenticity, such as ‘What do you hope to do with your career in this specialty?’ and ‘If you don't match through the SOAP, what do you think you're going to do next?’”

Go further: What to know about SOAP's last-minute Match options

“If you're trying to demonstrate to a program director that you are going to not only withstand the rigors of training in their program but thrive in that environment, appearing sad or coming apart or desperate—even though that may be the way you feel on the day that you learn you haven't matched—conveying that sentiment in an interview or in an opportunity to pursue a position is not going to get you where you want to go,” said Dr. Andrews.

“That sounds harsh, but everybody understands that the demands of residency training are high,” Dr. Andrews added. “A part of selecting applicants is understanding who will cope with those pressures and thrive in that environment. You need to show that you’re resilient in the face of this terribly disappointing news you've received, and you're going to move forward in a positive fashion.”

“I want to understand that they like the continuity of experience with patients,” said Dr. Edje, regarding family medicine residency applicants. “I want to know that they like the comprehensiveness of the care that we have. Family medicine is a three-year program, and what we don't want to do is to have somebody transfer right after their first year."

Learn more: What to do when you don’t match

“I had a disciplinary issue during my third year, where I was late to one of my rotations, and I got disciplinary probation for that, and I had to apply with that,” said Dr. Wolbrueck. “And what I did with that I think ultimately did help me, because I was very upfront about it. I said what I did to improve on that, and how I've demonstrated that there's not been any recurrence since then, and I think that that was a key way that I was able to help myself going forward.”

“People really appreciate that honesty and that acknowledgment,” said Dr. Lee. “And if you can reflect on why you ... had those difficulties matching and communicate that in your interviews, I think it really goes a long way to showing resilience and adaptability. I think that's what everyone's looking for in a physician.”

“It's not beneath you to practice,” said Dr. Edje. “Set some time aside. Have somebody Zoom link you in, and have them right off the top start with the more challenging interview questions. No ‘Hi, how you doing?’ Just get straight to it.” 

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“One of my best friends didn't match that year either, and I thought he was one of the smartest people in my class,” said Dr. Wolbrueck. “I knew other people in the same situation where you figured that’d match easily and they didn’t. It seemed like there wasn’t any rhyme or reason.”

“It taught me that it did not reflect my medical knowledge or my medical abilities,” said Dr. Malhotra.

“There are many reasons that people fail to match,” said Dr. Andrews. “It's worth thinking a little carefully and clarifying for yourself to the degree that you're able. Maybe it’s something tangible like a failed exam, or something less so like how they came off in an interview. I think if you can be really honest with yourself and deal with what happened openly, it would be really helpful for moving forward.”

Dive deeper: If you’re feeling disappointed on Match Day, you are not alone

“One thing I regret was not ranking all the programs that I interviewed at, and I think it is a common mistake,” said Dr. Lee. “The only reason to not rank a program is if you would prefer not being a doctor that year. People told me that and I didn’t listen the first time.”

“​​One of my friends had to switch to family medicine, and he ended up loving his career and family medicine,” said Dr. Wolbrueck.

“We all tell ourselves: I've got to be this kind of a doctor,” said Dr. Sarosi. “But really what you want to be is a doctor, and you will have an unbelievably satisfying career in some specialty—even if it's not the one you thought you were going to go into. I was going to be a transplant surgeon when I was a fourth-year medical student. I went in a different direction and I’ve had a wonderful career. So be flexible.”

“I imagine that we all went into medicine for similar goals, of taking care of patients ultimately,” said Dr. Wolbrueck. “And you will still be able to do that one day, even if it’s in a different area than you originally envisioned as a fourth year.”

Find out more: So you matched to a residency program—now what?

“We have six categorical residents for our general surgery program and we interview about 120 people for them,” said Dr. Sarosi. “That’s become typical of a lot of programs in that they interview way more people, because especially with the virtual process now people can interview with a lot more places more easily.”

“Protect yourself by paying attention to the facts,” said Dr. Edje. “For example, 93% of folks who were in the Match last year matched by the end of the SOAP period. It’s an intense week, so take all the emotions and put it into learning this process.”

Keep learning: As Match Day approaches, 6 things to keep in mind

“The specialty that you're interested in will usually have an annual meeting between now and next year when the applications open,” said Dr. Malhotra. “If you're able to go and attend those meetings, go and meet the program directors right at their tables. Introduce yourself. It might feel embarrassing or a little awkward but if you have the means and ability to go, give it a try.”

“I had a friend who did not match ophthalmology, so he took a research role,” said Dr. Lee. “He ended up matching in ophthalmology the next year because he built those connections. He worked really hard to get papers out, and he matched in his preferred specialty.”

“Doing research with an assistant professor is not going to help you as much as with a program director or chairman,” Dr. Sarosi advised. “If you work for a chair of a department, and they love you, they're going to find a way to help you out.”

Learn more: Concerned about matching? Experts offer 3 reasons for reassurance

“All of these people you’ve spent the last four years with are having a big moment, and actually a big part of resilience is social connection,” said Dr. Sarosi. “It'll be awkward, but you'll also be so proud of your friends, and supporting them actually will make you feel better. Sitting alone in the dark will not help at all.”

“Watching my close friends open up their envelopes, and celebrating with them was such a strong experience,” said Dr. Lee. “It was such a great time to be with them, even though I was kind of hurting at the time. But it really uplifted me emotionally, and set me up for success in the days to come, as I grappled with this new change in my life.”

“Once you're done grieving, if you have the privilege and the means to be able to—enjoy yourself,” said Dr. Malhotra. “You will not get time like this off ever again. So, it's also OK to enjoy yourself if you want to go on a vacation. Take some time with your family. Then consider research positions that you can help and you can add to your CV.”

“I would actually go ahead and jot down every single thing that you have done that has been successful for your life,” said Dr. Edje. “Just take time to do that to enjoy the things that you are very positive about. You’re going to have all this emotional energy. Use it positively.”

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