Ophthalmologist here. I am clinical faculty at the local medical university. This means I am in private practice but I am involved with the residency program because I like teaching. I give lectures, supervise clinics, and operate with the residents. I also participate in the resident selection process. While I do not have any role in the final rank list that is submitted to SF Match (ophthalmology and a few other specialties uses its own rank system but it operates the same way) I am privy to the discussions that take place determining who is where on that list. I may be able to offer a perspective on her experience.
First, there are a lot of truths in this piece. There is a problem with a system that leaves any US senior unmatched. That is a much longer discussion and one that does not have an easy answer in today's climate. However, as others have pointed out, there must be more to this story than is being presented. When your own program will not take you for a prelim surgery spot you have seriously pissed someone off. I have sat in candidate interviews (our program does panel interviews) where an AOA, 260 step 1, Ivy graduate will rub everyone in the room the wrong way to the point where the decision is made then and there not to even rank them. The comment about a rural program asking about what outdoor activities she enjoys hits the mark as to her lack of understanding of the process. When we are interviewing you, we know you can do it. What we want to know is will you be a good fit. That is all. Nothing more. Will you mesh with the faculty and other residents? Will you enjoy it here? A happy resident is a good resident. We ranked an applicant in the top ten (or we planned to do so) with 203 step one because he made us all laugh. He was academically exemplary in every other way, he had just had a bad day when he took step 1. He ended up matching to our program. My point is, a failed step 1 should not preclude getting a spot as long as it was passed the second time around. What is telling is the perceived lack of support from OHSU. Your school should be playing every angle to get their grads a spot. It does not look good for them when their grads don't match - sort of a mark of shame. The scramble is when favors are called in and phone calls are made. It should have taken one call from a dean or program chair calling and saying to a peer with an open spot "you need to take this person" to get her a spot SOMEWHERE. Also a truly superlative letter of recommendation will trump almost any "blemish". A formulaic or "good" recommendation isn't worth the paper it is printed on. Also, I give recs that have not been seen by the applicant more weight - I feel they are more honest and objective, than those that have. MS4s reading this, pick your recs very carefully. Waive your right to read them but be damn sure the person writing it thinks you are a rockstar. From a sort-of insider perspective to this process there is a disconnect between her perception of the situation and how it played out. When no one will give you a spot, not even your own program, there is a reason and it is more than just a failed step 1.
In conclusion, this was an nicely penned, but ignorant, piece. Casting blame on the system (which is admittedly very broken) but taking no hard look on what she could/should have done differently helps nothing. If it was a piece just to vent then it accomplished its goal. I have nothing but sympathy for her situation. If I could offer her any advice it would be apply again and do not give up. Fix what is lacking and keep trying, it will happen for her eventually. Programs have openings all the time as people drop out, change their minds, etc. Be available when a spot opens.
