I recently read several articles outlining the struggles that unmatched MDs face. As a US IMG who was in this situation about 7 years ago, this subject hits close to home. It was a difficult experience and I want to share my own journey in hopes of providing realistic encouragement and advice to others.
For context, I was an average medical student (pass/high pass) at an IMG program. I had a strong step 1, mediocre CK, and I failed the CS the first time around. This was mainly due to poor preparation leading to poor time management during the encounters. Although I retook the CS and easily passed a few months later, I ultimately did not match that year. I suspect I was screened out by many programs for the CS fail but I think I also failed to sell myself as a candidate. I took a job working in a clinical setting while I reapplied. I applied to 150+ IM programs and got around 12 interview invites and went to 10 of them. Thankfully, I matched this time.
I will never forget what it felt like to navigate that confusing limbo. Not matching was like hitting a concrete wall. Suddenly, for the first time in my life, I wasn’t making forward progress. Most of my med school friends were getting ready to take the next step in their lives and I wasn’t. In an instant, everything in my life was thrown into disarray--relationships, self-esteem, job prospects, finances—and I felt completely alone.
I wish I could say I handled rejection gracefully and went right into action mode, but I didn’t. I spent the first two months in self-pity playing a lot of video games. I was resentful and felt like pursuing medicine had been a huge waste of time. Forcing myself to sit down to write my new personal statement was the first step that helped me get out of that funk. From there, I worked my ass off and leveraged any connection or edge I had in the reapplication process.
Staying positive and productive was the hardest battle for me. If I could offer some advice to people in this situation--you need to find a way to stay really, really hard on yourself while at the same time not falling into despair. Your only objective for the next year should be to get your name on a program’s rank list. This starts with the humbling but necessary step of being brutally honest with yourself about why you didn’t match. Unfortunately, medicine as a profession is a breeding ground for entitlement and ego (we've all seen it in pre-meds to attendings). While irritating in a prideful intern, entitlement is poison to an unmatched IMG. There is absolutely no utility in blaming your school, PD, Trump, some difficult SP on your CS or your cheating ex-boyfriend for you not matching. Similarly, several of the articles I came across made the alarming insinuation that foreign IMGs were essentially stealing US residency spots. I find this line of thinking petty and delusional. Nobody stole my spot--or yours. We both failed to match despite the advantage of applying as US citizens. Start from there and avoid any mindset that removes agency from yourself.
I have no doubt that this experience made me a stronger as a person. I became more organized, driven and results-oriented in accomplishing my goals. That said, it was also an exhausting and lonely chapter in my life. One of the things that stood out was the lack of guidance I had for getting back on track. I came across many horror stories from other applicants but found little to feel hopeful about. This is because the normal thing to do once you finally match is to never talk about it again. Although we are all eager to move on, I think there is value in sharing success stories.
I want to let anyone in this situation know that there is hope and that this setback doesn’t have to define them. I am in a much better place in life with no lasting sequelae from not matching. Despite being an IMG deficient in interpersonal skills and medical knowledge (at least according to the CS and CK), I was selected as my program’s chief resident and scored in the top 10% nationally on my boards. When it came time to apply for fellowship, I learned from my past mistakes and matched to a top program. My priorities have shifted from getting back on the rails to deciding where I am actually going. These days I am focused on spouse, kids, mortgage and working as an attending. I carved out a second chance for myself. For many unmatched MDs, your opportunity is out there too!
I am an optimist but I would feel disingenuous if I didn’t also present the other side of the coin. In the pool of thousands of unmatched US MDs, there are those who were overlooked due to fixable factors (bad luck, inadequate preparation, poor soft skills, poor program/specialty selection) and those who unfortunately lack the credentials to ever match (I came across these applicants while on my program’s admissions committee during chief year). Things like conduct issues, substance violations, multiple failed steps, and numerous years out of training become extremely difficult to explain away, especially as an IMG. If you are in this category (like several people I know) you will likely need to make radical compromises in location/specialty or seriously consider contingency plans outside of clinical medicine. Part of your job during your first unmatched year will be to figure out which category you fall into and how to decisively pursue the options in front of you. Regardless of your situation, there is always more to you than medicine.
I wish everyone good luck!
For context, I was an average medical student (pass/high pass) at an IMG program. I had a strong step 1, mediocre CK, and I failed the CS the first time around. This was mainly due to poor preparation leading to poor time management during the encounters. Although I retook the CS and easily passed a few months later, I ultimately did not match that year. I suspect I was screened out by many programs for the CS fail but I think I also failed to sell myself as a candidate. I took a job working in a clinical setting while I reapplied. I applied to 150+ IM programs and got around 12 interview invites and went to 10 of them. Thankfully, I matched this time.
I will never forget what it felt like to navigate that confusing limbo. Not matching was like hitting a concrete wall. Suddenly, for the first time in my life, I wasn’t making forward progress. Most of my med school friends were getting ready to take the next step in their lives and I wasn’t. In an instant, everything in my life was thrown into disarray--relationships, self-esteem, job prospects, finances—and I felt completely alone.
I wish I could say I handled rejection gracefully and went right into action mode, but I didn’t. I spent the first two months in self-pity playing a lot of video games. I was resentful and felt like pursuing medicine had been a huge waste of time. Forcing myself to sit down to write my new personal statement was the first step that helped me get out of that funk. From there, I worked my ass off and leveraged any connection or edge I had in the reapplication process.
Staying positive and productive was the hardest battle for me. If I could offer some advice to people in this situation--you need to find a way to stay really, really hard on yourself while at the same time not falling into despair. Your only objective for the next year should be to get your name on a program’s rank list. This starts with the humbling but necessary step of being brutally honest with yourself about why you didn’t match. Unfortunately, medicine as a profession is a breeding ground for entitlement and ego (we've all seen it in pre-meds to attendings). While irritating in a prideful intern, entitlement is poison to an unmatched IMG. There is absolutely no utility in blaming your school, PD, Trump, some difficult SP on your CS or your cheating ex-boyfriend for you not matching. Similarly, several of the articles I came across made the alarming insinuation that foreign IMGs were essentially stealing US residency spots. I find this line of thinking petty and delusional. Nobody stole my spot--or yours. We both failed to match despite the advantage of applying as US citizens. Start from there and avoid any mindset that removes agency from yourself.
I have no doubt that this experience made me a stronger as a person. I became more organized, driven and results-oriented in accomplishing my goals. That said, it was also an exhausting and lonely chapter in my life. One of the things that stood out was the lack of guidance I had for getting back on track. I came across many horror stories from other applicants but found little to feel hopeful about. This is because the normal thing to do once you finally match is to never talk about it again. Although we are all eager to move on, I think there is value in sharing success stories.
I want to let anyone in this situation know that there is hope and that this setback doesn’t have to define them. I am in a much better place in life with no lasting sequelae from not matching. Despite being an IMG deficient in interpersonal skills and medical knowledge (at least according to the CS and CK), I was selected as my program’s chief resident and scored in the top 10% nationally on my boards. When it came time to apply for fellowship, I learned from my past mistakes and matched to a top program. My priorities have shifted from getting back on the rails to deciding where I am actually going. These days I am focused on spouse, kids, mortgage and working as an attending. I carved out a second chance for myself. For many unmatched MDs, your opportunity is out there too!
I am an optimist but I would feel disingenuous if I didn’t also present the other side of the coin. In the pool of thousands of unmatched US MDs, there are those who were overlooked due to fixable factors (bad luck, inadequate preparation, poor soft skills, poor program/specialty selection) and those who unfortunately lack the credentials to ever match (I came across these applicants while on my program’s admissions committee during chief year). Things like conduct issues, substance violations, multiple failed steps, and numerous years out of training become extremely difficult to explain away, especially as an IMG. If you are in this category (like several people I know) you will likely need to make radical compromises in location/specialty or seriously consider contingency plans outside of clinical medicine. Part of your job during your first unmatched year will be to figure out which category you fall into and how to decisively pursue the options in front of you. Regardless of your situation, there is always more to you than medicine.
I wish everyone good luck!
