I thought about writing up a preemptive response to this situation, but personal life got in the way. Glad someone brought this up. I'm choosing to be semi anonymous but if you feel like you need me to reach out to you in the PMs I will do so. I was in your shoes last year. I remember the day like it was yesterday. Here is my advice/story:
First, and most important:
You need to take care of your mental health. Everyone on SDN is a super star, so it's hard to get empathy but the fact of the matter is nearly 25% of the people that apply to CT anes do not match. Your job now is to make sure that you know you're still an awesome anesthesiologist. You're literally competing against some of the best in the nation and there is no shame in not matching. despite me typing this, you're going to feel shame. That's just part of being human. The next steps is to step away from things and gather yourself. I remember i consciously made myself take personal time away from anesthesia just to have some me time.
Understand the game:
We really were nothing but professional students until residency, and some of us still don't see the big picture. Getting fellowships involve more about connections than merit. The match rate is 75%. but the match rate for someone without a fellowship attached to the residency is WAY lower. It doesn't matter if you score the 95 percentile on the ITE, PDs rather take a mediocre 70% ITE guy that I've worked with for 3 years. Oh this guy looks mediocre on paper, but my buddy from residency tells me he's God's gift to anesthesia. Then i'm gonna take him over this guys that looks great on paper. It's not unfair or unethical, it's just way it is.
Reassess your situation:
As
@FFP often alludes, fellowship year comes with its own opportunity costs. Are you in a position where you can let your debt sit 1 more year and do fellowship next year? Is cardiac such a big deal in your life that you either become a CT anesthesiologist or you won't be happy in life? Take some time away reassess your own situation. Like
@Consigliere said, it could be a blessing in disguise. Do you have red flags that you can't overcome?? Or was it something minor like you now have better letters of recommendation?
Possible paths from here:
-Reapply while keeping your eyes out for new opportunities:
You can re apply as a CA3. Perhaps you've made better connections since the first time? Perhaps you've signed up to take the advanced PTE and it's gonna look really good as a CA3 that passed the advanced PTE exam?
@AdmiralChz once gave me advice that there will be a non-insignificant # of spots that will open up (this advice was invaluable. thank you again
@AdmiralChz ). Email the places you've interviewed and keep an eye on SF match. In the last year, 4 spots publicly opened for newly approved fellowships spots (and many more unofficially because they got plugged internally or outside of SF match). But this path is not without its risks. You could be out weeks of vacation, thousands of dollars in traveling. It could be all for nothing in the end. After that, you get settled in a job for 1 year and then you're moving again if you match in the 2021-2022 fellowship year.
-Find a job that allows you to do cardiac:
These jobs are harder to find, but if you have a calling to do CT cases there are jobs out there that allows you to do them without a fellowship (most of them are farther away from big cities but I have a buddy that found a job in houston that allows him to do cardiac). But know that on paper, you will be less appealing than someone that did a fellowship, even if you have all the clinical skills in the world.
-Enjoy life
Those CT people are jokers anyways. Sitting and doing bread and butter or supervising CRNAs could be just as fun.