Featured topic and speakers
Chhavi Chaudhary, MD, didn’t Match through the traditional channel or SOAP. Now a first-year fellow in the child and adolescent psychiatry division at Washington University School of Medicine in St. Louis, she offers insight on coping with not matching and how unmatched applicants can find a position.
- Chhavi Chaudhary, MD, fellow in child and adolescent psychiatry, Washington University School of Medicine
- Brendan Murphy, senior news writer, American Medical Association
- Todd Unger, chief experience officer, American Medical Association
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Unger: Welcome to Making the Rounds, a podcast by the American Medical Association. In this episode, we continue our “Meet your Match” series with guest Chhavi Chaudhary, a first-year fellow in the child and adolescent psychiatry division at Washington University School of Medicine in St. Louis. She shares her experience going through SOAP after not getting an initial match in 2019. She also covers advice and steps to take if you initially do not match. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to “Meet Your Match,” a special series on Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy senior news writer at the AMA. Today, I'm happy to have with me Dr. Chhavi Chaudhary, as we continue our series exploring all you need to know about the Match. This episode is going to detail what to do if you don’t match. Thanks for joining us, Dr. Chaudhary.
Dr. Chaudhary: Thank you for having me.
Murphy: Dr. Chaudhary is a first-year fellow in the child and adolescent psychiatry division at Washington University School of Medicine in St. Louis. To start us off, would you tell our listeners a bit about your background and how you navigated the Match process?
Dr. Chaudhary: Hi, everyone. Thank you so much for having me on this podcast to discuss this very important topic. In 2019, I did not match psychiatry residency. What happened afterwards was a rollercoaster of going through the SOAP. I did not get a position in the SOAP either. After that, I actually did, I changed my remaining electives in fourth year to different specialties to kind of get a letter of recommendation. I spoke with a lot of my mentors, APDs and PDs of psychiatry, the dean of my medical school. I sent out many applications for other research positions that I could be doing in gap year. And I continued to interview if I could get any availabilities for positions that were unexpectedly opening.
And it wasn't until May of 2019 that I eventually did get a position in psychiatry residency at a program that I had interviewed at during the interview cycle. It was an unexpected positioning. So throughout this process, I experienced the emotional turmoil that can come with going unmatched and also just navigating that process. I made a lot of mistakes and some things that worked out for me, clearly, and others that did not. And for the last four years, I have been sharing that with other applicants that have gone unmatched. I would start by saying that I am a U.S. medical graduate, and my experience is based from that. I hope that some aspects of what I share is helpful to all from different walks of life and from different roadmaps that they have taken to become a Match applicant. And I'm really excited to be here to discuss that with you guys.
Murphy: Thank you for those valuable details, Dr. Chaudhary. Could you walk us through what you did after not getting a match—what happened and how you were able to ultimately find a match?
Dr. Chaudhary: Yeah. After I received the email that I did not match, I prepared to go into the SOAP. I did all rounds of the SOAP for 2019 year. That year there were a lot of technological glitches, so there were only two SOAP rounds that were done. I had two interviews during the SOAP for specialties that were other than psychiatry. And then after the SOAP, I did many other things to get a psychiatry position or a residency position. And until May of that year, I did get a residency position in psychiatry at a program that I had interviewed at during the interview cycle.
Murphy: You mention SOAP. A valuable detail for our listeners is that SOAP will be taking place March 13 through 16 this year. And also, you mentioned you did find a position and we're so glad that you did. What do you think is the biggest misconception that medical students and other residency applicants have about what to do when they get that email from the National Resident Matching Program, the NRMP, that says, "We are sorry you did not match to any position"?
Dr. Chaudhary: Well, I think when you get that email, the first thing is you feel like it's over, that you've failed and that there is no path forward, and that is not the truth. The truth is that now the process has also just began as far as gaining a position after the Match. You have multiple cycles of SOAP to get ready for. Many people find positions even after the SOAP, such as myself, so I encourage during that time is really to take some time to reflect and also, of course, process the news, but also don't get caught up in the doom that email also has some people feel, because there are many different steps to take forward after that. It is not over just yet.
Murphy: That’s really valuable advice. What would be your insight on how to deal with that feeling that many residency applicants feel when getting the news that they did not match?
Dr. Chaudhary: I think it's valid to feel that emotional gut punch. You have an applicant who it's not just about the last four years of medical school, but it's really about a dream that's been alive for much longer than that, so that emotional gut punch is very natural, common and valid to feel. And I think a lot of medical trainees have this expectation that they should just be moving forward. And I think going into the SOAP process, if you haven't really processed that emotion, it's hard for it to not come up during your SOAP interviews or going through the SOAP process. So, I would say, in that moment, you really just sit with it and process it and also realize that your value and worth is not just on this one email sent by a computer-formulated algorithm.
Murphy: Do you think every residency applicant should have a break-glass-in-case-of-emergency-I-didn't-match-plan in place before they get that email Monday of Match week? And if so, what role should preparation play in this process?
Dr. Chaudhary: I think preparation is key to success in the post-Match process. It's very hard, unfortunately, with the short crunch of time between getting the email that you did not match and having to go into the SOAP to make a lot of decisions, such as, I wish I had prepared on how I was going to allot my applications for the SOAP, such as if there was no availability in psychiatry, then what would I apply for? And if I would even apply to something, because that is a decision that some people take, is that if there's nothing available in their specialty, they may not wish to apply, and they may wish to take a gap year and they may wish to reapply to that specialty. So coming up with, for example for me, internal medicine was a rotation that I very much enjoyed, and also one of my letter writers was from my internal medicine rotation. So how many of the applications in the SOAP did I want to allot to that, versus a transitional year, versus a prelim year, versus family medicine, potentially. So, I think preparing for that is very important just because it is more overwhelming, especially in a state where you're already very emotional, to continue on and make those decisions.
Another thing to really work on prior is if you do decide that there might be another specialty that you may want to apply into, then having a general personal statement that's uploaded to ERAS already may also be helpful. Going into the SOAP when you're applying, most of your application is going to be geared toward a certain specialty, and the interviewees and programs that are in the SOAP already kind of know that you did not match into another specialty, potentially. So, there's no hiding there, nobody really needs to hide there. We're all in the same boat there. But having a personal statement that talks about why another specialty, such as internal or family or whatever, how you did enjoy that, that can be easy to just send to those applications that you're going to send in the SOAP, versus after the Match coming up with that, right?
Or also in the ERAS, you can have more letters of recommendation, so having a general letter of recommendation might also be helpful in sending that with your SOAP application. So, I do think a lot of this is preparation prior that can really help with being successful in the SOAP process and also having more emotional control as well.
Murphy: That is fantastic advice. Too many medical students who fail to match don't just suffer a career setback, it can threaten their identities and even prompt a mental health crisis. How would you respond to those who don't match and feel that they're somehow a "failure” because of it?
Dr. Chaudhary: Yeah. As a medical professional, this is years and years of training. Many people decide to go into medicine in high school or even younger, and there's a process through college and then now you're in medical school, you've gone through four years of medical school. So, your identity can be very enmeshed by the advancement in that career and your identity professionally and personally. And so when there's such a setback where the advancement or not taking the traditional route of advancement in this career can be very impactful for how one perceives themselves. And also, there's a huge social aspect to this identity as well, and the setback, so how do I view myself personally and professionally? And then also, how do others view me? How do my classmates view me who are posting about their matches? How do my faculty and my letter writers, who have I let down? So, it is natural to have that enmeshment over identities. However, I think it's very important to realize that our accomplishments are not our identity and that is really important. So you really have to look into other aspects of your life, other achievements, personal, whether it's your relationships with your family, whether it's other goals as well, that your worth is not dependent on this specific perceived failure because you have not failed just yet. There's many accomplishments that you have already achieved to get to this position. It is just the idea of not being able to advance as expected that seems like a failure.
Murphy: You are uniquely qualified to speak to this topic for a number of reasons. One of them is you are now pursuing a fellowship in psychiatry. What resources should residency applicants who don't match draw upon if they feel they really are in crisis?
Dr. Chaudhary: This is a very important question, and in my work, the reality is every year, many, many people reach out to me, whether through its social outlets or even word of mouth from my medical school in this process, and they express the mental crisis that they are experiencing. I remember specifically in my year, on a Reddit thread, somebody did say that they were having suicidal thoughts. And I think in this process, and for the students that are in the SOAP process or do go unmatched; unfortunately, this is not an uncommon experience. And so I do think I want to definitely emphasize that if you're in crisis and you're feeling unsafe, you're engaging in risky behaviors, whether it's more substance use or impulsivity, things that are out of your character, you're very isolated to even people that are very close to you and you do not feel safe, then we need to seek emergency services.
Whether that's emergently going to our ER or dialing 988, which will route callers to the National Suicide Prevention line. The previous National Suicide Prevention line number is still active, which is the 1-800-273-8255, and that's always available. Another resource would be Physician Support Line, and many medical students feel like Physician Support Line is not for them—that is not true. That is for all medical trainees, so residents, fellows, medical students included. And the Physician Support Line is 1-800-409-0141.
Other resources that a lot of people forget to reach out to, a lot of medical schools, I think almost all medical schools, have a student counseling center and that can be part of the preparation phase where if you know that depending on how many interviews you've had during the cycle or what your application looks like and in preparation for this phase, you may want to schedule an appointment ahead of time for Match day or the next day or that week with the counselor at the student counseling center. Maybe we need to have an appointment ahead of time made with our psychiatrist or therapist. So, those are very important aspects that if you find yourself in crisis or anticipate crisis if you have a history of depression or a history of previous inpatient hospitalizations or previous suicidal attempts, then I think that seeking those services are absolutely needed.
And I highly encourage also coming up with a safety plan. When you find out that you don't match, it can be emotional flooding and it's hard for our brain to really make decisions in a way that we normally would. So, that's why it's important ahead of time to also, maybe, coming up with a safety plan like coming up with warning signs that you notice in yourself that a crisis could double up. Also coming up with people and places that you can reach out to because, unfortunately, in medicine, this is a population that people don't seek support because of what they perceive as failure and the enmeshment of their identities into the accomplishments that we achieve in this field.
So, having a plan and seeing that, "Yeah. When I created this, I said that I would reach out to this person," can be very helpful. So, I really, really hope that if you're a listener right now who found out that you did not match and you're having a crisis episode—please, please reach out to these resources.
Murphy: I love the idea of pre-planning a meeting with a mental health professional, and if you do match, then I'm sure you’re going to be glad to have that on the books and you can always cancel at the last minute if you don’t need it. That same advice and more was given in our last episode by Dr. Chantal Young from USC’s Keck School of Medicine. So, if listeners want to tune into that episode, episode nine of Meet Your Match, I’d encourage you to go back—it’s in this feed.
Dr. Chaudhary: I would also add that it can be hard for students, and it can be hard for Match applicants to identify a crisis episode in themselves. And so, this is not a process that is only impactful to the unmatched applicant—there's classmates who have had their medical school friends who are going unmatched. There are faculty who has recommended these students for these positions and mentors and their school administrators as well. So, I would also add on and advise to these classmates and to these faculty members and school administrators to also provide support, check-ins.
The dean of my medical school scheduled a meeting with me later that day after the SOAP was over to check-in. And I had classmates who, of course, are celebrating their own matches. However, if you are part of a class where your friend or your classmate did not match, please do reach out to them because it can be quite isolating in that moment.
Murphy: Fortunately, you did ultimately land a psychiatric residency position in May of what would be your first year of residency. What words would you like every residency applicant who doesn't match to hear loud and clear from you?
Dr. Chaudhary: Yeah. I think what I definitely want the listener to know is that you have not failed. You have already accomplished so much to be here. You've taken long, grueling tests. You've already shown that you are worthy and equipped with all the knowledge and skills to be a resident and to contribute to humanity with the skills that you've gained throughout this process. So, I definitely want them to know that they have not failed and your dreams are not over because there is different roads taken to getting a residency position and continuing on your training that maybe look different for other people. And what many students may not realize is that that looks different for many people. Yes, there's a huge part of where people take the traditional route, and then there's others like me who don't match, who don't SOAP and afterwards, get a position in the same year later on in a completely unexpected way.
There's others who I know who have done a preliminary and then gotten into a specialty that they applied for. There's others who have taken different routes in medicine and been happy and fulfilled in doing that. Taking gap years, worked on their MBA or other avenues that they have done, and eventually gotten on the path that they wanted to be on, got in the position that they wanted in a different path. So, I really want them to know that they have not failed and they're fully equipped to be a wonderful physician. It is unfortunate that a lot of this is dependent on a supply and demand and funding and increasing residency spot, and just systems. And so, I think what breaks my heart the most is people feeling that they are not worthy when in reality, they are just as worthy, it's just that the system isn't equipped to help them realize their hopeful dreams.
Murphy: And of course, the AMA has and is continuing to advocate for more federal government funding for increased graduate medical education positions.
Dr. Chaudhary: Yes, one of the most fulfilling things about my Match that, still to this day, I have many emotional experiences about, but one thing that's helped me process that and for the last four years that I really felt was fulfilling was advocacy in this area. And there's several different organizations that have advocated, one such as Alliance of Medical Graduates, and other people who have gone unmatched and created websites such as unmatchedmd.com, which I've utilized during my Match when I went unmatched. So, I think the most important part is also continuing advocacy about this. And a lot of these organizations or people also have support groups for unmatched applicants or have meetings and you can feel united in that experience and it can be a little bit less isolating for these individuals as well. And so, I do encourage people to continue advocacy in this group.
Murphy: Thank you so much for agreeing to join us today, Dr. Chaudhary. Sharing your perspective is one small step to decreasing that isolation that people might feel if they don’t match. This has been Making the Rounds, a podcast by the American medical association. I’m AMA senior news writer, Brendan Murphy. Until next time, thanks for listening.
Unger: You can subscribe to Making the Rounds and other great AMA podcasts anywhere you listen to yours or visit ama-assn.org/podcasts. Thank you for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.