You, in general, have to reapply. People who fail to match, particularly those who fail to match into competitive fields, may apply for a different speciality the second time around. A decent number of people in my class failed to match EM, and I wouldn't be surprised if many of them end up in IM or family. On the other hand, some people try to boast their application and reapply to the same speciality. I have a bud who wants orthopedics bad, so he spent the last year doing research. And then some people fail to match because they make a dumb rank list, like interviewing at 10 places but only ranking 2 programs. These people just need to to apply to a bunch of programs and be less picky. People doing Traditional rotating internships get paid the same as other residents/interns, which is around 50k depending on your location.