Failed to match NSG. Reapplying to Radiology-Diagnostic. Chances?

[longhaul3]

I have to disagree and say those students would be grateful. They may be resentful towards those programs they believe should have matched them, but they should be thankful they inevitably matched. I don't think this would lead to a less productive or happy resident because I guarantee not matching in your desired field is worse than matching at your lowest-ranked school.

Fair point, although I don't think you can count on that. I would have been pissed if I had matched at any of the programs in the bottom 1/3 of my rank list (yes, better than not matching, I agree), whereas applicants who were excited about those programs were probably excited to match there and, I would argue, better serve the department's best interest. Also, if a star applicant fell far down his/her list, that could be worrisome in and of itself.

I guess this is an area where the match process can be improved. If there was an objective way of signalling serious interest aside from those often ignored love letters, then programs wouldn't have to be doing this guesswork/making assumptions as to who really wants to be there. It seems like many people have gotten burned over the "You're too good for us, so I'm gonna yield protect and rank you low" thing over the years.

They've discussed an option like this in the ortho literature. You get to flag your "top 3". Only you and those programs know about it. One downside of this is the 100% guaranteed "Why weren't we in your top 3?" on interviews.

This is interesting. What about having that option post-interview, when you make your rank list? Obviously that would lead to inflation of those flags, like it would be a requirement to spend one on HSS to have any chance to match there, whether you really wanted to or not.

I don't think longhaul3 would necessarily disagree, it's just that programs want to minimize that as much as possible. One bad apple (someone that doesn't really want to be there) is enough to spoil everything. These surgical subs are generally smaller programs, so when you have one person with a poor attitude it can really affect things. Plus no one wants to work with someone that doesn't want to be there for 5+ years.

I agree with this. There aren't too many programs that I know about that really have bad apple problems, except those at which the entire tree is rotten and they like it that way.

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[slowthai]

This is interesting. What about having that option post-interview, when you make your rank list? Obviously that would lead to inflation of those flags, like it would be a requirement to spend one on HSS to have any chance to match there, whether you really wanted to or not.

Thinking about it, that's even better, honestly. This, coupled with completely banning post-interview communication would give applicants more control over their destiny.

 

[Mass Effect]

Wow, that's upsetting because I thought I was just a random lottery winner but if 17 interview invites doesn't guarantee an anesthesia spot, the system may truly be faulty. Thanks for the encouragement, mate.

Yeah, I used to think it was the system too, and then I started interviewing applicants. Trust me when I say it isn't the system. In 99% of these cases, it's the interview.

Everything you say makes sense, but we had a surgical subspecialty applicant get burned by our department and fail to match this year, and ProgDirector has commented in other threads that not only do PDs often prioritize matching high on their list, others they answer to will use it to judge their performance as PD.

Unlike with admission to medical school, there's no committee involved in your fate now. It's up to one person with final say on the rank list. Shouldn't surprise us at all that yield shenanigans are common

Actually, there IS a committee. It isn't all dependent on the PD, though the PD certifies the list and can change it prior to certifying. Usually that's done with the aPD and others. PD acting totally solo is highly unusual in my experience.

 

[efle]

Yeah, I used to think it was the system too, and then I started interviewing applicants. Trust me when I say it isn't the system. In 99% of these cases, it's the interview.




Actually, there IS a committee. It isn't all dependent on the PD, though the PD certifies the list and can change it prior to certifying. Usually that's done with the aPD and others. PD acting totally solo is highly unusual in my experience.

Yikes really...so it's multiple physicians, who each understand the Match algorithm, sitting around and agreeing with each other about high match > best match. Even worse.

 

[slowthai]

You can demonstrate serious interest- away rotations! You'll meet applicants on the trail who are "really really" interested in a program because their family is nearby or some other reason, but then you ask why they didn't do a subi there and they have no answer. Obviously it's not really their top preinterview season choice if they don't even apply for an away. Do an away rotation, show them that you fit, explain why you want to be there, and it will work out if they like you and you meet their standards.

The "you're too good for us, so I'm gonna yield protect and rank you low" thing, in my opinion, is as true a statement as the "it's not you, it's me" break up line.

I don't know, these failed matches are happening to people that check all those boxes, along with good interview performance.

 

[libertyyne]

You can demonstrate serious interest- away rotations! You'll meet applicants on the trail who are "really really" interested in a program because their family is nearby or some other reason, but then you ask why they didn't do a subi there and they have no answer. Obviously it's not really their top preinterview season choice if they don't even apply for an away. Do an away rotation, show them that you fit, explain why you want to be there, and it will work out if they like you and you meet their standards.

The "you're too good for us, so I'm gonna yield protect and rank you low" thing, in my opinion, is as true a statement as the "it's not you, it's me" break up line.

The downside of this is , there are only so many away rotations you can do. And advisors arent doing a service to people either when they arent clear on this fact. I asked my PD where I should do aways and they said it doesnt matter , just select a few places. Like look at my app and tell me where I have the best chances and what i should do. It is a small field with barely 100 programs.

I don't know, these failed matches are happening to people that check all those boxes, along with good interview performance.

There is still a chance that even with everything you fall through the cracks due to geography, preferences, and an unusually strong match.

 

[slowthai]

There is still a chance that even with everything you fall through the cracks due to geography, preferences, and an unusually strong match.

Agreed, purely because it's a numbers game. Sometimes people lose out just because there aren't enough spots. They were strong candidates with no deficiencies. All I'm saying is that it would be great if the match could be improved by taking out the guesswork and minimizing the gamesmanship. It would help both programs and applicants. Programs would have greater assurance about who actually wants to be there and applicants can increase their chances of matching.

 

[augeremt]

Part of what makes an applicant to any given program desirable is the extent to which they want to be there. It is not necessarily in a weaker program's best interest to rank the superstar applicants the highest, because on the off chance they match there, they will be miserable and resentful. This outcome is not in the best interest of the program.

Sometimes the differences in how people rank programs are not as pronounced as you make it out to seem. It could be as simple as having an educational fund or money on your card that makes the difference in rank. Just because you're ranking a program #2 or #5 doesn't mean you will be miserable matching there. There are subtle differences in personal preferences and med students change rank lists up until the deadline because of this.

Ranking a program #6, for example, is MUCH different than #18. I'm sure I'd still be happy if I'd gone down to #6, but not so much for #18.

 

[Mass Effect]

Yikes really...so it's multiple physicians, who each understand the Match algorithm, sitting around and agreeing with each other about high match > best match. Even worse.

Snark notwithstanding, no, they don't sit around and agree with each other about high match. They sit in a room and review applications AND interview impressions and decide who they want to rank where. For the record, I've never heard a PD talking about not wanting to go down low on the rank list and I've sat in on several of these rank meetings. Generally, the discussion revolves around impressions on interview day (with PC and resident evaluation input), academic performance, then communication/interview performance. Sit in on a rank meeting and your default answer to why someone with high scores didn't match will become "you need to work on interview/first impressions," regardless of field.

I don't know, these failed matches are happening to people that check all those boxes, along with good interview performance.

How do you know they had good interview performance? Because they say so? You'd be surprised how many smart people fumble through the interview.

 

[efle]

Snark notwithstanding, no, they don't sit around and agree with each other about high match. They sit in a room and review applications AND interview impressions and decide who they want to rank where. For the record, I've never heard a PD talking about not wanting to go down low on the rank list and I've sat in on several of these rank meetings. Generally, the discussion revolves around impressions on interview day (with PC and resident evaluation input), academic performance, then communication/interview performance. Sit in on a rank meeting and your default answer to why someone with high scores didn't match will become "you need to work on interview/first impressions," regardless of field.



How do you know they had good interview performance? Because they say so? You'd be surprised how many smart people fumble through the interview.

Sounds like your experience has been with good PDs and aPDs. But there are plenty out there who do play the yield game and assume applicants "will end up somewhere much bigger." As far as knowing that's the reason, it was literally said to someone during their SOAP a couple weeks ago, when they were being offered the same spot that the PD hadn't believed they would want.

 

[slowthai]

How do you know they had good interview performance? Because they say so? You'd be surprised how many smart people fumble through the interview.

No, because they report good interview feedback from both their interviewers and their mock interviewers.

 

[differentiating]

Sounds like your experience has been with good PDs and aPDs. But there are plenty out there who do play the yield game and assume applicants "will end up somewhere much bigger." As far as knowing that's the reason, it was literally said to someone during their SOAP a couple weeks ago, when they were being offered the same spot that the PD hadn't believed they would want.

I might be missing something here, but this implies that the PD didn’t even rank that person, in order for both the applicant snd the spot to be in SOAP, which goes beyond yield protection. So that doesn’t make sense as a reason.

I know one person from med school who didn’t match in Nsurg, but he had poor 3rd year grades and was terrible to work with, so it was inevitable. Assuming OP didn’t have similar issues (and I imagine not with that many interviews), it sounds like they were an unfortunate victim of the fact that there are more highly-qualified applicants competing for spots than spots themselves.

 

[AnatomyGrey12]

I might be missing something here, but this implies that the PD didn’t even rank that person, in order for both the applicant snd the spot to be in SOAP, which goes beyond yield protection. So that doesn’t make sense as a reason.

It was a prelim spot in the SOAP. The applicant in the match was ranked for categorical.

 

[efle]

I fully believe that this has been said to applicants, but why do you think it isn't just a nicety or something a PD says to avoid the awkwardness of saying "we don't feel like you fit with our team" or something similar? Telling someone that it's an impression issue is harder than saying it's a CV issue that could be fixed. If it was a "I'm surprised you SOAPed. If you still want to be in the field, make sure you apply to us next year and we will have your back. We would've ranked you higher if we didn't expect you to match somewhere better" that's one thing. If they just say that they are surprised and don't step up to make sure this mistake won't happen again next year, I would see it as a hollow statement

Why would a program who is so worried about yield bother interviewing someone they thought would end up somewhere bigger in the first place? Small fields interview 30-40 applicants and need to rank 5-7 applicants/per spot to fill. Programs aren't going to interview someone that they like, confirm they like that applicant at the interview, and then rank the applicant low enough that they definitely won't match at their program. It's a waste of the few interview slots they have. Even if a couple places did yield protect, there is still something more at play to not match after ranking >15 places.

I might be missing something here, but this implies that the PD didn’t even rank that person, in order for both the applicant snd the spot to be in SOAP, which goes beyond yield protection. So that doesn’t make sense as a reason.

I know one person from med school who didn’t match in Nsurg, but he had poor 3rd year grades and was terrible to work with, so it was inevitable. Assuming OP didn’t have similar issues (and I imagine not with that many interviews), it sounds like they were an unfortunate victim of the fact that there are more highly-qualified applicants competing for spots than spots themselves.

You are correct that it makes no sense, but it happened to someone I know.

Occams razor has to kick in at some point guys. If people who interviewed their way into medical school, got great evals on clerkships, are being told by their advisors/mentors that they are shocked and have no explanation, and are being told by PDs themselves that they thought it wasn't possible to match them, we have to do some serious mental gymnastics to still blame the applicant.

 

[efle]

It's not occam's razor when I have seen a handful of people this year in that exact situation, except everyone who knew the applicant in the interview setting was not surprised (well, I didn't see what the PD told them, but I assumed by their volume of interviews that the PD at the very least isn't saying anything bad). Even if the home and the away program institutions did yield protect, those are a couple programs and doesn't explain the other interviews. Either 1) it was a statistical anomaly in which case the applicant should just reapply to same field or 2) it's an interview problem and the applicant should find someone willing to give blunt feedback in order to cover their bases next year

There are more options than that. Like an applicant that is perfect on paper but largely applies and interviews at mid to lower tier programs by preference, then gets excluded from a bunch of their rank lists because they also interview fine and seem too good to match them.

 

[NotAProgDirector]

I have to disagree and say those students would be grateful. They may be resentful towards those programs they believe should have matched them, but they should be thankful they inevitably matched. I don't think this would lead to a less productive or happy resident because I guarantee not matching in your desired field is worse than matching at your lowest-ranked school.

I've seen it go both ways. The miserable resident experience sticks with a program, and poisons it for years.

Yikes really...so it's multiple physicians, who each understand the Match algorithm, sitting around and agreeing with each other about high match > best match. Even worse.

This doesn't happen anywhere near as much as you think it does.

The "you're too good for us, so I'm gonna yield protect and rank you low" thing, in my opinion, is as true a statement as the "it's not you, it's me" break up line.

It's common for someone who doesn't match at a program to reach out and ask why. Almost all of the time, you'll get a meaningless answer like "we matched higher on our list than usual". Yet the basic fact remains, they didn't match there because they were too low on the rank list. And they were lower on the rank list because they failed to impress the program.

I don't know, these failed matches are happening to people that check all those boxes, along with good interview performance.

I haven't seen any good statistics on how often this is happening. It may be very rare, with a few stories circulating. In a system with 25K matches, 0.5% would be 125 people.

Programs would have greater assurance about who actually wants to be there and applicants can increase their chances of matching.

Actually, not exactly. All spots fill eventually. If someone who didn't match gets a spot, then someone who got a spot now loses it. Unless you're suggesting that better information --> better applications and interviews --> more matches and less spots in SOAP. That's true, better because more people match and don't SOAP, but doesn't necessarily fix the topic discussed in this thread.

You are correct that it makes no sense, but it happened to someone I know.

Occams razor has to kick in at some point guys. If people who interviewed their way into medical school, got great evals on clerkships, are being told by their advisors/mentors that they are shocked and have no explanation, and are being told by PDs themselves that they thought it wasn't possible to match them, we have to do some serious mental gymnastics to still blame the applicant.

Ultimately, the applicant failed to convince any programs to take them seriously enough.

 

[slowthai]

Actually, not exactly. All spots fill eventually. If someone who didn't match gets a spot, then someone who got a spot now loses it. Unless you're suggesting that better information --> better applications and interviews --> more matches and less spots in SOAP. That's true, better because more people match and don't SOAP, but doesn't necessarily fix the topic discussed in this thread.

I agree. What I meant to say is that the "stronger" applicant that failed to match due to assumed lack of interest would theoretically be able to show interest by putting the program in their top three, potentially increasing the likelihood of being placed high on a program's rank list. This would likely increase their chances of matching.

I'm really advocating for a truer "match" between applicant and program. And yes, because it's a zero sum game, someone will "unfairly" lose out everytime. The applicant to spot ratio is just too high for these highly competitive fields.