If you put together a gold standard app, but fail to match, do you lose a year?

[Habeed]

I'm a few years out, and I am by no means certain I want to do neurosurgery. However, I think that a specialty like this one or similar might be a best fit, and so I am going to work as hard as I possibly can to max out my performance in medical school.

Assume, for the sake of argument, that I succeed. I score in the top 5% of the class my clinical science years, and above 250-260 on Step 1. I earn junior AOA. I score 2/3 As and 1/3 Bs in my clinical rotations, and I manage an A in all surgery rotations including neurosurgery electives. (I am trying to leave some margin for people not liking me and giving me less than perfect grades in some rotations). I do a 3 months summer research position specifically in neurosurgery between years 1 and 2, and I complete some other research in my first year of med school.

From what I have read, this is a "Gold standard" package. It is about as well as I could possibly do.

So I apply to every NS program I can afford, assuming I still want to do it in 4 years, and due to sheer bad luck (perhaps every program that I am competitive for has their spots filled by someone who has "connections" with the PD) I fail to match.

Could I do year 1 of a preliminary GS program, or do intern year in a categorical GS or other surgical program that I interviewed and ranked as a "safety"? Then, rematch? Or would I end up losing a year this way, because if I did match the second time I would have to repeat intern year at most NS programs...

I am just curious if my ambitions really are limited by "rolls of the dice".

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[eldo]

No... there is no roll of the dice. If you put together something even close to that package (the average Step 1 for NSGY is 236 and only something like 25-30% of matched applicants are AOA) you will match provided that you are easy to get along with and are a hard worker. More important than all of the things listed are to get to know the people at your home program and do several away rotations. A lot of who matches where is based on conversations between program directors and residents about you.