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Medical Students Without Residency Matches Have Options

Delece Smith-Barrow, Ilana Kowarski

Few days are as important as Match Day for a medical school student.

Dozens of videos on YouTube show students crying tears of joy and hugging classmates as they finally learn, this year on Friday, March 20, where they will spend the next three to seven years doing their residency. This day marks the unofficial end of medical school and the beginning of a career as a doctor.

On the Monday of Match Week, students learn if they were assigned to a residency program. Unassigned students who the National Resident Matching Program, or NRMP, deems to be eligible for a residency can obtain one via the Supplemental Offer and Acceptance Program, a several-day process that allows students to compete for unfilled residency positions.

[Read: 3 Ways Medical Students Can Excel in Residency Interviews.]

Before SOAP was created, students went through a similar process called "the scramble." But even with coordinated, last-minute efforts to place students, some still find themselves without a residency.

"Medical students who go unmatched typically feel that they are somehow inferior, and many can face imposter syndrome or significant symptoms of depression and anxiety as a result," Dr. Patricia Celan, a psychiatry resident at Dalhousie University in Canada, wrote in an email. "Students who feel demoralized by going unmatched need to remember that acceptance into medical school and graduation from medical school are both remarkable achievements, demonstrating incredible intelligence and dedication."

Getting Ready for Match Day

Dr. Eric Mizuno, an internist and medical director at the OMNI Medical Student Training Program in Chicago, says medical school seniors should emotionally prepare themselves for the stress of the match process.

The best approach is to hope for the best and prepare for the worst, says Mizuno, a former clinical assistant professor of medicine at Northwestern University's Feinberg School of Medicine in Illinois.

He notes that medical students need to make a realistic assessment of their competitiveness so they can set achievable goals for themselves and aim for specialties where they are likely to secure residencies.

[Read: Choose a Medical Career to Suit Your Personality.]

Michael A. Gisondi, associate professor and vice chair of education in the department of emergency medicine at the Stanford University School of Medicine in California, says there are typically two types of medical students in the lead-up to Match Day: the "worried well" who excelled in medical school and had plenty of residency interviews vs. med students who had "blemishes" in their file and did not secure a significant number of interviews before Match Week.

Students in the latter group should consult with their academic advisers or dean's office to seek guidance, Gisondi says. "This a process where you do not go it alone."

Obstacles That Can Prevent Matching

Experts say sometimes medical students don't match due to a flawed residency application strategy.

For example, they might have applied for residencies in highly competitive specialties, such as dermatology or orthopedic surgery, even though their medical school performance makes them unlikely candidates for residencies in those fields.

Or they may have applied for residencies only within a popular geographic region such as Southern California. They also might have placed too few schools on their ranking list.

"I tell medical students they should always put at least five places," says Dr. Stephen Klasko, president of Thomas Jefferson University in Philadelphia and the CEO of Jefferson Health. He encourages students, particularly those who didn't initially get a residency placement, to expand the number of hospitals where they are willing to go within their chosen specialty or consider choosing a different specialty.

Another issue that can prevent residency matching, experts say, is if a medical student has low licensing exam scores or if there is something problematic about his or her academic performance in medical school classes.

[Read: The Difference Between D.O. and M.D. Degrees.]

"Those students are going to have more difficulty getting into residencies," says Dr. G. Richard Olds, president of St. George's University, an international academic institution with a medical school that has its main campus in the Caribbean. "If you have a problem with your paper record, sometimes it's difficult to overcome that."

Olds suggests that students with an unimpressive test score can mitigate that deficit by applying to a residency program in the region where they grew up, since residency directors often prefer locals. Students can also try applying for a residency at a place where they did a clinical rotation and excelled, Olds adds.

Dr. Lynn Buckvar-Keltz, an associate professor of medicine at the NYU School of Medicine, says grades and exam scores matter when applying for residency but aren't the only factors. "Being an engaged, enthusiastic member of the clinical teams during the clinical clerkship is an important part of the student's medical school experience and therefore their residency application as well."

Gisondi notes that medical students who go through the SOAP process should do their best to be upbeat during phone interviews, despite whatever disappointment they feel about not being placed in one of the residency programs they initially selected. These students can draw inspiration from the positive memories they have about interacting with patients during clinical rotations, and they can share these stories during interviews, Gisondi suggests.

"The candidate who is dour and who stews in what was a really unfortunate life event, that's going to hurt them on the phone," he says, adding that residency program directors are looking for a "bright star" who can enhance their program.

Less Selective Specialties for Residency Applicants

Experts say that residency directors for primary care specialties such as pediatrics and family medicine tend to be more willing to consider students that other residency directors might overlook.

Olds notes that residency programs in the upper Midwest or rural regions may be more accommodating of residency applicants who don't have perfect credentials.

What to Do If You Don't Match With a Residency

If an aspiring physician is unmatched, there are a few options.

Olds notes that sometimes last-minute openings at residency programs appear after Match Week is over. But he says that unmatched medical school grads should come up with something to do that will improve their candidacy for the next match cycle.

Olds suggests possibly looking for a health care job involving quality improvement or informatics, paperless medical record-keeping or perhaps even hospital billing and collections. "Working in the health care field using your skills is certainly better than doing nothing," he says.

Unmatched individuals can contact their medical school and ask for a transitional slot, which mimics the fourth year of medical school and may even be tuition-free. An alternative is to seek a research fellowship, some experts say.

"If they do a transitional year or a research fellowship, they can then become more competitive in one of those specialties or they can decide to match in family medicine or general internal medicine where it's easier to get a slot," Klasko says.

However, Olds cautions that clinical research is more likely to improve someone's residency candidacy than bench research. He also warns unmatched medical students to consider whether working on a particular research project will improve their residency candidacy, and weigh that before they commit to such a project.

Both Olds and Klasko say that obtaining another graduate degree in addition to a medical degree can increase a student's chances of matching in the next cycle.

"Now all of a sudden I'm a pretty cool candidate," Klasko says. "It doesn't look like I'm somebody who failed. I'm somebody who decided to get a master's in public health or an MBA. Now I'm a differentiated candidate."

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