after you didn't match, what did you do?

[nitsasckya]

hello all,

I'm a U.S. citizen and will graduate from a U.S. allopathic school next month. I'll skip my sob story, but the bottom line is that I didn't match in IM this year, and I'm still 100% positive that I want to go into IM. I'm following the job openings posted on this site as well as residencyswap and findaresident, but I'm not crossing my fingers that I'll be the lucky one who gets whatever pops up, so I'm trying to prepare myself to apply/match next year.

I've already spoken with the PD at my school's affiliated residency program and have also been in contact with the dean at my school... I have a few ideas of what I might like to do over the next several months, but actually setting something up has been a very slow process (or so it seems), so I'm coming here to ask everyone who has been in my shoes:

What did you do between graduation and interview season? After interview season/before match? After match/before residency? (What did you want to do, if you weren't able to set something up?)

What would a PD that has no idea who I am want to hear that I've done in those time frames?

Thank you in advance for your responses!

--nitsasckya

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[digoybugoy]

I think if I was in your situation I would try to do some research with an attending who has projects that are easily doable. I matched this year but Im still doing research because I think its always going to help in the future. Plus it looks good that you did something with the year you had off. Choose a mentor who will be on top of things so you will have something to show for your work. You can take step 3 as well I believe and of course take a much needed vacation as well so you look fresh during your first day as an intern.

 

[dragonfly99]

I agree - try to find a research job in something related to IM, and work hard. I don't think there is a whole lot else you can do, honestly. Try to keep your feet in things clinically as well. Is there any way you can stay enrolled as a student so that you could volunteer at med student run clinics, shadow physicians, etc.?
I just think it would make it easier on you next year.
Another option would be do a 1 year master's degree or MPH or something.
If your step scores were a problem, then passing Step 3 might help to assuage the fears of future prospective program directors. If the problem was more personality conflicts, etc., then keeping some sort of foothold in clinical work becomes more important I think.

 

[digoybugoy]

The other thing I would suggest is applying to "less prestigious" programs. I know a lot of people in this forum only want to go to these name programs but I'm of the belief that if you find an academic program that will train you well you can do anything you want. I myself come from a less prestigious US school but our IM staff comprised of mostly IMGs match extremely well in cardiology, GI, nephro etc. Our residents are able to do lots of research because it is made available to them hence they can overcome the IMG stigma. I would have loved to stay at my program but I have a son and lots of research during residency will be almost impossible so I need as much "name" recognition as I can get.

 

[Speculatrix]

I'm a U.S. citizen and will graduate from a U.S. allopathic school next month. I'll skip my sob story, but the bottom line is that I didn't match in IM this year

While I am not asking for your sob story, I think it is highly relevant to why you didn't match. You might want to explore it in greater depth, because it is kind of a red flag to me that you didn't match into IM as a US allopathic student (knowing nothing else, or like that you only ranked BWH and JH for example). I think it would be difficult to set up a clinical elective without malpractice, etc., unless the other institution was somewhat lax or you had a good contact there. When you go from student to graduate, your status changes a lot. If you are badly needing to do a clinical rotation, to make up for poor clinical evals, it may be in your best interest to delay graduation so you can be covered as a visiting student, not an "observer" graduated physician. If it's lack of geographic diversity / interviews, apply wider. If it's USMLE, focus on Step 3, pump out some research, make lots of contacts at other residencies. Use your friends/classmates to help you out, and keep in touch with them, as they can give you a good "in" for a residency. Your prognosis + steps to fix it are unclear because your red flags are unknown. Remember that your future boss has only a few minutes to go through your application so you need to fix the red flags in easily quantifiable ways.

 

[jdh71]

I agree about finding a research gig, tell them you'll work for tech wages, and be prepared to supplement your income working at the starbucks if necessary.

Get a good letter from your PI. Reuse your letter from previous, if you think they were good, address your issue of not matching in your personal statement, and reapply MUCH more broadly - be realistic.

PM me if you like.

 

[Pkboi24]

While I am not asking for your sob story, I think it is highly relevant to why you didn't match. You might want to explore it in greater depth, because it is kind of a red flag to me that you didn't match into IM as a US allopathic student (knowing nothing else, or like that you only ranked BWH and JH for example). I think it would be difficult to set up a clinical elective without malpractice, etc., unless the other institution was somewhat lax or you had a good contact there. When you go from student to graduate, your status changes a lot. If you are badly needing to do a clinical rotation, to make up for poor clinical evals, it may be in your best interest to delay graduation so you can be covered as a visiting student, not an "observer" graduated physician. If it's lack of geographic diversity / interviews, apply wider. If it's USMLE, focus on Step 3, pump out some research, make lots of contacts at other residencies. Use your friends/classmates to help you out, and keep in touch with them, as they can give you a good "in" for a residency. Your prognosis + steps to fix it are unclear because your red flags are unknown. Remember that your future boss has only a few minutes to go through your application so you need to fix the red flags in easily quantifiable ways.

I will second that. Why didn't you match? It's highly relevant to the advice we give.

 

[nitsasckya]

--Edited--

Thanks to all for contributing !!

 

[Speculatrix]

This is really a much better picture of what happened. I would strongly encourage you to edit your post at some point within a week or so, since you may or may not want to have this as a permanent record on the Internet. Up to you, but that's what I would do.

I am so sorry to hear about what happened. I think you have a very strong chance of matching into IM. Your life/career is not over, and soon you will be able to put this behind you. Keep in mind that as a graduate, you are eligible to sign a contract outside the match (your home program may offer this), although I predict you will still have to match through NRMP given your test score history.

Assuming you're going to stay in the same city, I would try to "keep the iron hot" at your home program, by engaging in a research project with a faculty member in IM or subspecialty, preferably someone in the same subspecialty as the PD. Focus on research, but study a bunch for step 3, do the "manual release" score option in ERAS, and take it in mid-September+, if your NBME predicts a decent passing score. Realistically I think scores drop by 10-20 points on average, people with 250's step 1-2 who study for step 3 seem to top out at about 230, from what I've heard; Step 3 may not help, but it's a chore you can get out of the way before intern year. In a few months, e-mail your home program PD indicating you'd love to match there, inform that you've been working on a research project with X, and ask how you can increase your candidacy there since you love the place so much + are committed to the residents of that city and love the program. Obliquely find out about how ranking decisions are made at your home program (resident input? faculty input? a "score" system? PD as king?) and adjust accordingly. If residents/chiefs have a lot of say, then make sure they love you and go to bat for you. Go on your home school interview, do well, then email PD saying it's your first choice, etc. Don't overdo it with the emails though, strike a good balance.

If they are rejecting home school applicants at the home residency, then don't be too hopeful you'll end up there. So, you have to simultaneously widen your net significantly and apply to many more schools. I recommend at least 12-15++ if not more like 20+. Throw in some safeties like "good" community programs.

Make an appointment with your advising Dean NOW and/or chairman and brainstorm a realistic list of residencies to apply to given your credentials. You two can come up with 30+ at this time if not more.

Don't address your failure or low test scores on your application or talk about the personal issues. People will ask about it on the interview if they want. At that time you can honestly give them the reason, and talk about how you've strongly moved on from that and will give 100% to the residency program.

You will match.

 

[NotAProgDirector]

With the details provided, it's clear that you didn't match simply because you didn't apply broadly enough. Also, it sounds like you might have been able to scramble had you not had technical failures, and bad advice (assuming that someone in your med school's admin suggested that emailing programs would be effective, which it isn't). But, as you said, it's in the past now.

So, advice is relatively easy:

1. You're very likely to match next year no matter what you do. Hence, I would focus this coming year on what you WANT to do. I wouldn't simply go down to the Carib and hang out on the beach, but if you do research, or clinical work, or volunteer, or teach MCAT, or whatever -- most PD's won't care all that much. I would keep some clinical focus -- volunteering somewhere at a minimum.
2. I agree with considering taking Step 3 -- but the only reason to do so is if you think you can really do better. Agree with taking it after app submission with manual release.
3. What could you do? You could:
A. Split your 4th year. Many medical schools allow you to split 4th year over two years without charging more tuition. Would allow you to continue with clinical work. You might also be able to work some months and make some income. Would prevent you from taking Step 3 (You need to graduate to do that).
B. Research, but only if you're interested
C. Med assist -- perhaps you can get hired to take BP's and do other med assist tasks in an office. May not be possible as they may only hire "MA"'s
D. Transcription -- companies are looking for people with medical terminology skills to type dictations. You could do this part time while doing anything else.
E. Look for a PGY-1 spot off cycle. These open up - someone doesn't show, visa falls through, fails out, gets sick, gets pregnant and decides to drop out, any number of issues. Finding such spots is not simple, as there is no centralized listing. An IM PD will often know of them, so it's best to remain in contact if possible. if you're thinking about this option, then you should not make long term commitments. There is no question that you'll have more options if you wait for the next match cycle.
F. International volunteer -- Haiti might be possible. Sounds like you have a family, so that might not be a good option.
G. Teach -- maybe Anatomy is looking for people to help with prosections. Or does your school have standardized patients -- maybe you could be one?

 

[nitsasckya]

All,

Thank you so much for taking the time to contribute your thoughts and encouragement. I'm not typically one that asks for help but I'm overwhelmed with the lack of direction I've received thusfar, and your suggestions are golden. If I don't address what you've suggested somewhere below, I'm not ignoring your suggestions- I just don't have any questions to ask about what you said and I don't think it's vital to respond with simply, "Yeah, I'm looking into that," or, "That's good advice." Many of you have made excellent suggestions that I've not considered before now and I really appreciate it.

You can take step 3

That's an awesome idea, I don't know if I can though? I found this website and the state I live in requires that you are enrolled in a residency program in order to take step 3. Is this website accurate? If so, could I potentially travel to take step 3 in another state that has no requirements for license applications/enrollment in residency? (Would it matter if I took step 3 in, say, Arkansas but end up going to another state to do residency?)? This is definitely something I'd like to get out of the way before I start residency, if at all possible.

Try to keep your feet in things clinically

This is the #1 thing I'd like to do. I've been in contact with the dean at my school and she is looking into whether I could stay at my school unpaid/unaffiliated with the school/residency and function as a mini-resident (I suppose that's the best thing to call it?), so long as I get malpractice insurance and find faculty that are willing to work with me. No idea if this will go through or not. I would like to stay involved clinically so I don't lose the fluidity I have in interacting with patients right now. If this falls through, short of finding an alumnus from my school that works in the area, do I have any other well-known options (other than free clinics or medical missions) that would allow me to have clinical exposure to patients?

Is there any way you can stay enrolled as a student so that you could volunteer at med student run clinics, shadow physicians, etc.?

I don't know... when I met with my school's PD, it was strongly suggested that I not put off graduation (I think the insinuation was that I not put it off involuntarily), but a reason was not given. Did you bring this up since it is easier for students (vs. whatever I'll be after graduation) to do clinical rotations and volunteer at the free clinics, etc.? Could I potentially have many of the same opportunities if I do graduate and then pay malpractice insurance out of pocket, if I find a place that I could be involved with patients clinically?

Another option would be do a 1 year master's degree or MPH or something.

I've thought about an MBA, but I'm not sure how useful it would be to try to earn that degree before I go through residency. Any thoughts? As for an MPH, I've never been interested in getting an MPH... but having said that, I really have no idea what exactly that degree is, or what I could do with it. After residency, I anticipate that I'll be a hospitalist or go into critical care +/- pulm. Would there be any advantage to having an MPH in either of these scenarios?

Remember that your future boss has only a few minutes to go through your application so you need to fix the red flags in easily quantifiable ways.

Don't address your failure or low test scores on your application or talk about the personal issues. People will ask about it on the interview if they want.

Speculatrix, both of these points are great- I feel like they're a bit contradictory though to my situation. Ideally, I would really like to follow both pieces of advice when I reapply to programs later this year... my question is, do you think my application will speak for itself (LOR's, board scores, dean's letter -- the stuff I can't change) to stand alone without addressing anything else? I could be wrong, but I feel like the number of interviews I am offered will be limited unless I say something about my personal issues, even if it's in a very vague sense that opens the door for them to ask more. What do you think?


Thank you again,

--nitsasckya

 

[Speculatrix]

Others can address your other concerns... but, your step 3 question: don't worry about the "state", you can apply through any state board, you don't have to be a resident there or ever have the intention of practicing there. For ease, I would just register through Connecticut. You can find more details at the FSMB site, but you will be able to apply immediately after graduation. There's a form you mail in with a notarized photo of yourself but the rest is pretty much electronic.

As for the "not addressing the reasons" question... do you remember the golden rule of dating? Never bring up exes on the first date. If you apply widely, you'll make the first cut, and any PD you meet with in person will ask you about the circumstances of your red flags. Bringing it up in the application is just asking for a reason for them NOT to invite you to interview.

This "mini-resident" status may hurt you more than it can help you, I think. That is just another opportunity where you can potentially falter. I would go for clinical research instead with the goal of publishing something and not leaving that section of ERAS blank. I would try to work with a clinician who publishes a lot, perhaps someone on the tenure track (look up "assistant professor" - they kind of have to publish or perish, so they may be keen on establishing themselves in the academic world).

If you do get permission for this soft-observer thing and go that route, plan out the timing well... interns start in July, so you might not want to do it then. Plan out when it will fit with your step 3 and other plans too, and perhaps keep it limited to a month or something. You don't want to overwhelm anyone, as people may just get tired of you and it could backfire. Even if you forget how to do an H&P or physical, that will all come back to you pretty quickly. (as long as you don't go >1 yr without residency)

 

[NotAProgDirector]

That's an awesome idea, I don't know if I can though? I found this website and the state I live in requires that you are enrolled in a residency program in order to take step 3.

As mentioned, this whole sponsorship for Step 3 is crazy. You can have ANY state sponsor you, and then you can take it in any other state. So, once you graduate you can sign up for Step 3. Doing well on it will be key, or put it off until after applications are in.

I've been in contact with the dean at my school and she is looking into whether I could stay at my school unpaid/unaffiliated with the school/residency and function as a mini-resident (I suppose that's the best thing to call it?), so long as I get malpractice insurance and find faculty that are willing to work with me.

Problem is, you will also need a medical license to do anything. You will no longer be a medical student. Without a license you might be able to be an "observer" -- not allowed to touch any patients, do any documentation, etc.

I don't know... when I met with my school's PD, it was strongly suggested that I not put off graduation (I think the insinuation was that I not put it off involuntarily), but a reason was not given. Did you bring this up since it is easier for students (vs. whatever I'll be after graduation) to do clinical rotations and volunteer at the free clinics, etc.? Could I potentially have many of the same opportunities if I do graduate and then pay malpractice insurance out of pocket, if I find a place that I could be involved with patients clinically?

I have no idea why your PD thought that delaying graduation was bad. You're either going to have to explain why you didn't match the first time, or why you delayed your graduation -- the answer to both questions is exactly the same. Delaying graduation (if possible) would allow you to do ANY clinical activity that a medical student could do. Graduating would allow you to get a job, although perhaps not clinical. Graduating also give you a chance at getting an off cycle spot for next year. But it makes getting additional clinical experience difficult. It's not a clear win either way -- you'll need to decide what's best for you.

 

[ResidentMD]

As mentioned, this whole sponsorship for Step 3 is crazy. You can have ANY state sponsor you, and then you can take it in any other state. So, once you graduate you can sign up for Step 3. Doing well on it will be key, or put it off until after applications are in.



Problem is, you will also need a medical license to do anything. You will no longer be a medical student. Without a license you might be able to be an "observer" -- not allowed to touch any patients, do any documentation, etc.



I have no idea why your PD thought that delaying graduation was bad. You're either going to have to explain why you didn't match the first time, or why you delayed your graduation -- the answer to both questions is exactly the same. Delaying graduation (if possible) would allow you to do ANY clinical activity that a medical student could do. Graduating would allow you to get a job, although perhaps not clinical. Graduating also give you a chance at getting an off cycle spot for next year. But it makes getting additional clinical experience difficult. It's not a clear win either way -- you'll need to decide what's best for you.

Playing devil's advocate here, but if the OP graduates from a US med school (with good clinical evals), then would not mid tier univ programs be happy to snap him/her up via a prematch ?That would also give OP the security of getting into a residency program and not risking the match. Does the clinical experience matter that much? He/she can volunteer or something (probably see patients weekly at a homeless patients' clinic).

Again, a lot of this depends on whether the OP has a good application.

Also, are there any issues between the OP and his/her PD? Because in that case, you may not want to solely rely on that person for advice. Who knows, you take all the advice and do exactly as he/she says, and still not match into your own program again 😱

 

[Speculatrix]

Playing devil's advocate here, but if the OP graduates from a US med school (with good clinical evals), then would not mid tier univ programs be happy to snap him/her up via a prematch ?

No. USMLE failures constitute red flags that would preclude a prematch, at least in my opinion.

 

[ResidentMD]

No. USMLE failures constitute red flags that would preclude a prematch, at least in my opinion.

Hmm..I didnt look into that. Yeah, probably best not to hedge your bets on it unless someone at a program really wants you there.

 

[NotAProgDirector]

Playing devil's advocate here, but if the OP graduates from a US med school (with good clinical evals), then would not mid tier univ programs be happy to snap him/her up via a prematch?

No. USMLE failures constitute red flags that would preclude a prematch, at least in my opinion.

I should have mentioned that also -- by graduating the OP would have a chance at a prematch, simply starting off cycle (i.e. filling a slot left open by someone else pre-July), or trying for the match again. The downside is less clinical experience (perhaps).

A USMLE failure is not certain to prevent a prematch, but clearly not help.

 

[DrJosephKim]

Make the most out of your 1 year by doing research, writing online, networking, and building your personal brand. This way, you'll show that you remained productive during that year (even if you worked in a restaurant). Spend some time doing some things that will boost your credibility.

 

[ResidentMD]

Make the most out of your 1 year by doing research, writing online, networking, and building your personal brand. This way, you'll show that you remained productive during that year (even if you worked in a restaurant). Spend some time doing some things that will boost your credibility.

Could you be more specific regarding "writing online"?

 

[dragonfly99]

I don't see how "writing online" will help his application. I'm not getting it.
I vote for either trying to not graduate and doing a 1 year MBA or research, with continued clinical work/volunteering, or just graduating and looking for an off-cycle spot, while simultaneously applying via ERAS. If he graduates he can still get a research gig potentially, but opportunities for clinical work will be very limited due to not having any status, liability wise (i.e. not being a student but not having malpractice insurance to work as a doc in any capacity).

 

[futureres]

All the advice posted here is sound advice, especially in searching for a prematch spot. I would only stress wholeheartedly (as some others have) that applying to only 6 programs (especially if they were top 25 academic programs) is a huge problem considering the competition, and that for the second go around you should be more aggressive and broad in where you apply. Since it's a 2nd try in IM, applying to 20 wouldn't hurt. Keep in mind that failing the boards and not matching in a not-so-competitive specialty are huge red flags, so getting interviews will be hit/miss based on this. I'd mix it up-less competitive academic programs plus some strong community programs as well. You can get great training in a lot of places...just please apply to many diverse programs.