Didn’t Match ENT, Landed in IM – Where Do I Go From Here?

[desperate4MD]

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Hello SDN,

Yesterday’s Match Day didn’t go as I had hoped, and I’m looking for some guidance and clarity on my situation moving forward.

I’m a fourth-year medical student at a mid-tier medical school who matched into a mid-tier university internal medicine program. My primary goal this past cycle was to match into otolaryngology, and my entire ERAS application was tailored toward ENT. I completed a dedicated research year (with strong productivity), performed well on my ENT rotations, obtained solid letters of recommendation from faculty, and built a CV with relevant ENT experiences. In my opinion, I interviewed well and my grades were good overall, though my Step 2 score was on the lower side (<245), which I believe may have been the main weakness in my application.

This cycle, I was fortunate to receive 8 ENT interview invitations, all of which I ranked. On the advice of faculty at my school, I also applied to a few internal medicine programs as a backup. Yesterday, I learned that I matched at my 10th-ranked program (an IM program), which was unexpected.

While I recognize how competitive ENT is and feel grateful to have matched, I can’t help but feel disappointed, as I was strongly hoping to pursue ENT. I remain very interested in the field, but I’m unsure what realistic options are available now that I’ve matched into an IM program.

Here are the paths I’ve been considering:

1. Complete my intern year in IM and try to apply to any open or off-cycle ENT positions that may arise
2. Complete IM residency, strengthen my application (including Step 3 and additional ENT research), and reapply to ENT
3. Withdraw from the Match agreement and pursue another dedicated research year with my previous mentor
4. Give up on ENT completely and try to get an IM procedural fellowship

I would really appreciate any advice, especially from those who have been in similar situations or have insight into switching into ENT after matching into another specialty.

Thank you in advance for your help.

 

[NotAProgDirector]

Happy to try and help.

First, I know you're unhappy with the situation, but it's unlike that this is something that you "did" to cause. ENT is hyper-competitive, and good people just don't get spots. It's unfortunate, but it's the way it is. I know that doesn't make you feel any better now, but hopefully you won't blame yourself for this.

You matched in IM. Whether or not that was a good idea, it's done now. So let's review what your options are going forward.

Withdraw from match agreement -- there is no such choice. The match is binding. if you "withdraw" because you just don't want to do the IM spot and rather have ENT, you will not get a match waiver. If you don't get the waiver, you could be banned from the match for 1-3 years. Theoretically, the match is binding for 45 days. So, you could start at your new program and tell them day 1 that you're resigning on day 46. But that may leave you in a very tough spot -- when you apply again next year, is any non-ENT program going to consider you? I'd be worried you'd do the same thing again.

Apply after/during PGY-1 -- This is an option. You could apply again during your PGY-1, 2, or 3. Applying again as a PGY-1 won't change much. You'll be applying in August of your PGY-1. Your PD letter is going to say "just started, seems OK so far". The rest of your app is likely to be exactly the same. You'll also have the problem of trying to interview while you have a PGY-1 job. You got 8 IV this year, you can expect 1/2 or less next year with an essentially unchanged application. And you risk upsetting your program -- they don't want to be short a PGY-2 and you won't know until mid March whether you get a spot or not (which is very late for them to be filling a PGY-2 position). Thus, there would be some chance that they would try to fill the position earlier, and leave you with an ultimatum -- give up your PGY-2 spot or withdraw from the match. Some programs will give you a hard time, some will not. The app process is much easier in PGY-2 (since being short a PGY-3 is usually less of a concern for programs), and it's seemless in your PGY-3. being fully trained in IM might be seen as a plus in the ENT app process, although I'm not certain about that.

One problem with any re-app is funding. Now that you've matched to IM, you get three years of full funding. If you apply to ENT, you'll have two years (or less). After you use your three years, you have reduced funding -- it's about 75-80%. All fellowships are funded this way. Some programs will care. Many will not -- they are often "over cap" anyway (meaning that some of the resident get no funding no matter what) so it really doesn't matter. This is especially true at big academic programs, which is where many of the ENT training programs are going to be.

You already did a full research year. Others here can chime in, but unclear how much more research will help.

The last option comes after IM, so that you can address as you go. Although, if you want one of the competitive IM fellowships (cards, GI) and you spend 2+ IM years doing ENT research, you may find those hard to get also as they can be competitive.

 

[Apollyon]

Happy to try and help.

First, I know you're unhappy with the situation, but it's unlike that this is something that you "did" to cause. ENT is hyper-competitive, and good people just don't get spots. It's unfortunate, but it's the way it is. I know that doesn't make you feel any better now, but hopefully you won't blame yourself for this.

You matched in IM. Whether or not that was a good idea, it's done now. So let's review what your options are going forward.

Withdraw from match agreement -- there is no such choice. The match is binding. if you "withdraw" because you just don't want to do the IM spot and rather have ENT, you will not get a match waiver. If you don't get the waiver, you could be banned from the match for 1-3 years. Theoretically, the match is binding for 45 days. So, you could start at your new program and tell them day 1 that you're resigning on day 46. But that may leave you in a very tough spot -- when you apply again next year, is any non-ENT program going to consider you? I'd be worried you'd do the same thing again.

Apply after/during PGY-1 -- This is an option. You could apply again during your PGY-1, 2, or 3. Applying again as a PGY-1 won't change much. You'll be applying in August of your PGY-1. Your PD letter is going to say "just started, seems OK so far". The rest of your app is likely to be exactly the same. You'll also have the problem of trying to interview while you have a PGY-1 job. You got 8 IV this year, you can expect 1/2 or less next year with an essentially unchanged application. And you risk upsetting your program -- they don't want to be short a PGY-2 and you won't know until mid March whether you get a spot or not (which is very late for them to be filling a PGY-2 position). Thus, there would be some chance that they would try to fill the position earlier, and leave you with an ultimatum -- give up your PGY-2 spot or withdraw from the match. Some programs will give you a hard time, some will not. The app process is much easier in PGY-2 (since being short a PGY-3 is usually less of a concern for programs), and it's seemless in your PGY-3. being fully trained in IM might be seen as a plus in the ENT app process, although I'm not certain about that.

One problem with any re-app is funding. Now that you've matched to IM, you get three years of full funding. If you apply to ENT, you'll have two years (or less). After you use your three years, you have reduced funding -- it's about 75-80%. All fellowships are funded this way. Some programs will care. Many will not -- they are often "over cap" anyway (meaning that some of the resident get no funding no matter what) so it really doesn't matter. This is especially true at big academic programs, which is where many of the ENT training programs are going to be.

You already did a full research year. Others here can chime in, but unclear how much more research will help.

The last option comes after IM, so that you can address as you go. Although, if you want one of the competitive IM fellowships (cards, GI) and you spend 2+ IM years doing ENT research, you may find those hard to get also as they can be competitive.

What I really like about this post was the added comment about indirect medical education. So many folks parrot that about "you won't be funded", but they don't know the meat and potatoes of DME vs IME. Likewise, the "above cap" - spots in excess of the 1997 limit. You make it so clear - you should be a program director. Oh, wait....

 

[operaman]

It sounds like your application was as strong as it could possibly be given the fixed aspects you can’t change like a step 2 score. Definitely don’t break your match agreement - your chances of matching next time are even lower than this last time. Another research year probably won’t help much either - you did all the right stuff already but sadly it just wasn’t enough to overcome the insane odds.

I would vote for sticking with IM entirely, and at most just toss in another ent app this cycle and see what happens. The hope might be that there’s a suddenly less competitive year - when I was a resident there were 2 years where apps were down and one where a couple programs had to SOAP. There were articles saying our specialty had lost its appeal to students, but then obviously that didn’t happen. So maybe you get lucky, but don’t jeopardize your sure thing for a longshot.

 

[neriticzone]

I would stick with IM, it might be an option if you start strong your intern year to talk to ent pd and im pd about your situation and see if there is anyway that could work out within your institution. I don’t know how the IM match works internally but someone saw all the ent stuff in your application. But with IM training there is such a broad swath of specialties you can apply to as well you can probably find your niche. I think a lot of people in med school fixate on the one perfect specialty. In reality I myself think I could have been happy doing a few different things, and there are certainly days where I wished I was doing something else.

Don’t let this match result take away from what you have achieved so far, it’s a crapshoot in ent.

 

[Pir8DeacDoc]

I would stick with IM, it might be an option if you start strong your intern year to talk to ent pd and im pd about your situation and see if there is anyway that could work out within your institution. I don’t know how the IM match works internally but someone saw all the ent stuff in your application. But with IM training there is such a broad swath of specialties you can apply to as well you can probably find your niche. I think a lot of people in med school fixate on the one perfect specialty. In reality I myself think I could have been happy doing a few different things, and there are certainly days where I wished I was doing something else.

Don’t let this match result take away from what you have achieved so far, it’s a crapshoot in ent.

This is solid advice. While in the moment it feels like your life/career will be a disaster if not in your "first" choice, the reality is there are many great fields in medicine. Do Pulm, GI, Interventional Cards, etc. Something where you can keep yourself in the procedural game. Best regards