What Happens When You Don’t Match Into Residency…Twice

Two years ago I interviewed a fellow Caribbean medical graduate. I interviewed him because of his failure. Specifically his failure to match into residency. I wanted to shed light on what the medical education community seems to shun and ignore- what happens after you fail to match into residency. Last year we were both hopeful that we would be able to share a comforting update on his path toward residency. His story was seemingly not yet ready to be told because for the second year in a row he heartbreakingly failed to match into a residency position. However, as the old adage goes, third times the charm.

It’s been two years since I interviewed you the first time. Back then you were recoiling from not matching into residency. Then you went through the match for a second time. What did you do during that first year after not matching your first time?

Hi Marc, it’s been quite some time and I’m happy to be back talking with you and answering your questions. After the first time of not matching, I began the process of getting my MBA in Health Services Management, studied for Step 3, and worked part-time for Ross University as a standardized patient. I also shadowed one of the pediatricians I worked with to keep my clinical skills fresh as she saw both adults and children.

How did you deal with the emotions of not matching for a second time?

To be quite honest, at first, I didn’t deal with the emotions. I was rather numb for a while and chose to ignore the feelings. But I started to really develop that anger more than I felt the depression stage of grief (Kubler-Ross knew what she was talking about). I had a hard time accepting the fact I did not match, considering what a program director told me, in which they implied that I was going to match at that program. I felt betrayed and became distrustful in the whole process.

What strategies did you change the second time around? Different specialties? How many interviews did you get the second time? Why don’t you think you matched the second time? 

I applied strictly to Family Medicine, which I definitely felt comfortable doing and I had wanted to really do it after attending the AAFP National Conference in July 2016. I met a lot of people and had some meaningful conversations with program directors. However, with all that said, I only had two interviews. It wasn’t that I was a repeat applicant that held me back, but it was the fact that I was never able to obtain a letter of recommendation from a board-certified Family Medicine physician. I do not believe that it was my interviews that did me in, but simply the numbers were against me.

So it’s your second match day and you find out you didn’t match, again. Take me through that week for you. 

It was a dark week. No…a dark couple of weeks. I was teaching our Ambulatory Care Competencies elective, which prepare MS-IV’s for Step 2 CS. We had finished around 10:45 AM and as I was walking to my car, I get the e-mail AGAIN that states “You did not match.” Again, there was no “oh hey girl” or “what’s going on” or anything like that. Just a simple “You did not match.” I immediately drove back to our school’s campus and got to work on SOAP. I actually had a phone interview at a university-based internal medicine program for a categorical position, which did not happen the year before. I spoke with three people and I naively felt very optimistic, thinking I was going to get the position. Well, the rounds of offers went by and there was nothing. It was very difficult to show up to work on Tuesday being surrounded by people who were celebrating having matched. In no way, shape, or form was I jealous or bitter. I knew that all of our journeys were our own and our applications were all different. However, it was just a little tough to be happy around them because I wanted to know what that feeling was like, so I took a break from social media. When I did that, the outpouring of support via text and email came from my former classmates and colleagues. So many people voluntarily reached out to me offering positive thoughts and were willing to put in good words for me for the next process. These people knew my work ethic and personality and were willing to put their reputation on the line by recommending me. That was a huge motivation for me to keep going and to get back on the horse again.

What did you do for the year after your second time not matching? Where did you work? 

I managed to get a full-time position with Ross University teaching for their Internal Medicine Foundations clerkship. However, I wasn’t even on their radar! According to the requirements, I was too far removed from graduation to be hired but they took me on the team on a per diem basis, if you will. I was working 40 hours a week, but just for the six-week clerkship. Unfortunately for one of the hires, he was unable to take the position and I had proven myself worthy of the position. They liked my teaching and mentoring style so much that they ended up offering me a full-time job and eventually, I became the Chief Clinical Teaching Fellow. I went from not even being considered for the team to becoming the team captain, which gave me the confidence going forward in the application process and it was something that I spoke about in my interviews.

Fast forward to your third time going through the match. You finally get a categorical position in internal medicine. What do you think was different this time around?

Well, my MBA was finished (and I graduated with highest honors) and my Step 3 score was in. I had taken Step 3 in January 2017, hoping to have it in time for the rank order list that was due in February 2017. Of course, I was part of the group of exams that wouldn’t get their score until May. May 2017 rolled around, and I passed so this showed that I am in good standing to eventually pass the boards, whether I ended up in Internal Medicine or Family Medicine. I also finally got that FM board-certified LOR for my application, which was a bonus since the writer is also a program director. Also, I was working on getting published in a medical textbook.

I knew that it was going to be very difficult to get residency interviews on my own, so I had to reach out to as many people as I could that were in residency programs. I asked people to talk about my character and work ethic. I looked at as many Family Medicine programs as I could and saw what scores they were looking for and narrowed Internal Medicine programs to the east coast and Chicago. Overall, I applied to 260+ programs. To my surprise, within the first week, I had my first interview offer and within four weeks of applying, I had four interviews lined up. I also constantly checked for new programs that were opening up and applied to those, which gave me some additional interviews. Overall, I had 3 IM interviews and 5 FM interviews (one of them was an interview I had last year, for which I was really grateful). Some of the interviews were from the help of people in the program, but that’s the main help I received. It helped me get my foot in the door, but I had to impress in the interviews. I did not take that help for granted and realized that I was not only representing me, but I was also representing them.

Do you know a lot of other students who didn’t match? What about people like you who didn’t match multiple times? What do people do who don’t match for a third time? What would you have done?

I have heard of a handful of students who matched after a third or fourth attempt. After I matched, I posted my story on Facebook and I got a huge number of messages with people asking for ideas on how to help them match and the best I could do was help brainstorm. Everyone’s application is different and since I don’t know what’s on their application or record, I could only speak on what I ended up doing.

To be quite honest, I don’t know what I would have done if I hadn’t matched a third time. I have been living in Florida already for my rotations and one thing that I was considering was applying for my ACN (Area of Critical Need) license. Since I had passed all the Step exams, I would’ve been able to practice medicine under the license of another primary care physician.

What general advise do you have for pre-med students researching Caribbean medical schools with regard to match rates? Did your medical school have resources available to you after you didn’t match?

Match rates are definitely useful, but you have to take them with a grain of salt, as you do with the match residency placements. Sure, Ross has matched at Yale and Duke, but you have to realize they are a rarity and have worked with the right people to earn that opportunity. However, use that as motivation to push yourself further to get that opportunity. Also, be aware of the school’s data. Take a look at what year the data came from because it may be slightly outdated. Take a look at where the graduates are able to practice. Even if you transfer into a “Big Four” (I guess Big Five school with AUA) medical school for your rotations, where you did your basic sciences will limit where you can obtain licensure so keep that in mind before you go to a cheaper Caribbean medical school. The extra cost is completely worth it.

What advise do you have for medical students who don’t match? What about if they don’t match twice?

Excellent question, Marc. Simply do not give up. It’s not a matter of if you will match, but rather WHEN you will match. Do not be afraid to reach out to colleagues who are in residency programs. I was hesitant at first because I wanted to earn it on my own merit, but if other industries interview people based on reference from those within the company, why can’t we do it in medicine? I know many people who got residencies because their parents knew people. My parents are not physicians. No one in my family is a physician. However, my friends from medical school could vouch for me, which in my opinion, carries more weight as there is no obligation to push for me.

Also, take Step 3!!!! You might as well get it out of the way, especially if you have lower scores like me, a failed attempt, or need a visa for residency. It can definitely open doors because every single interview mentioned that they were glad I had Step 3 done. One PD told me that it was a deciding factor in my application. In the words of Larry the Cable Guy, GIT ‘ER DONE.

To see our original interview after Steven’s first failed match check it out here- what happens when you don’t match.

Thank you again Steven for being so open and honest about your success and failures. I wish you only the best during residency and beyond.

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